Stroh Christine, Köckerling Ferdinand, Volker Lange, Frank Benedix, Stefanie Wolff, Christian Knoll, Christiane Bruns, Thomas Manger
*SRH Municipal Hospital Gera, Gera, Germany †Vivantes Hospital Berlin, Berlin, Germany ‡Department of Surgery, University Hospital Magdeburg, Magdeburg, Germany §StatConsult Magdeburg, Magdeburg, Germany ¶Institute of Quality Assurance at Otto-von Guericke University Magdeburg, Magdeburg, Germany.
Ann Surg. 2016 May;263(5):949-55. doi: 10.1097/SLA.0000000000001559.
Laparoscopic sleeve gastrectomy (SG) is an upcoming procedure in bariatric surgery and is currently performed worldwide. Staple line leakage, as the most frequent and most feared complication, is still a major concern.
Since 2005 data from patients undergoing bariatric procedures in Germany have been prospectively registered in an online database and analyzed. All patients who had undergone primary SG within a 7-year period were considered for analysis.
Using the German Bariatric Surgery Registry, data from more than 11,800 SGs were collected between January 1, 2005, and December 31, 2013. Staple line leak rate decreased from 6.5% to 1.4%. Male sex, higher body mass index, concomitant sleep apnea, conversion to laparotomy, longer operation time, a combination of buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate compared with when using either buttresses or oversewing alone. On multivariable analysis, operation time and year of procedure only had a significant impact on staple line leakage rate.
Owing to the growing experience a constant decrease in the leakage rate after SG has been observed. Staple line disruption may still lead to sepsis, multiorgan dysfunction, and increased mortality. The results of the current study demonstrated that there are factors that increase the risk of leakage and which would enable surgeons to define risk groups, select patients more carefully, and offer closer follow-up during the postoperative course with early recognition and adequate treatment.
腹腔镜袖状胃切除术（SG）是减肥手术中一种新兴的术式，目前在全球范围内开展。吻合口漏作为最常见且最令人担忧的并发症，仍是一个主要问题。
自2005年起，德国接受减肥手术患者的数据已前瞻性地登记在一个在线数据库中并进行分析。所有在7年期间接受初次SG的患者均纳入分析。
利用德国减肥手术登记处的数据，在2005年1月1日至2013年12月31日期间收集了超过11800例SG手术的数据。吻合口漏率从6.5%降至1.4%。与单独使用支撑物或缝合相比，男性、较高的体重指数、合并睡眠呼吸暂停、转为开腹手术、手术时间较长、支撑物与缝合联合使用以及术中并发症的发生与显著更高的漏率相关。多变量分析显示，手术时间和手术年份仅对吻合口漏率有显著影响。
由于经验的积累，SG术后漏率持续下降。吻合口破裂仍可能导致脓毒症、多器官功能障碍和死亡率增加。本研究结果表明，存在一些增加漏率风险的因素，这将使外科医生能够界定风险人群，更谨慎地选择患者，并在术后过程中进行更密切的随访，以便早期识别和进行适当治疗。
