Mahmoud Maysoon, Maasher Ahmed, Al Hadad Mohamed, Salim Elnazeer, Nimeri Abdelrahman A
ACGME-I accredited Surgery Residency Program, Abu Dhabi, United Arab Emirates.
Bariatric and Metabolic Institute Abu Dhabi, Department of Surgery, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
Obes Surg. 2016 Mar;26(3):679-82. doi: 10.1007/s11695-015-2018-7.
Leak following laparoscopic sleeve gastrectomy (LSG) is one of the most serious and devastating complications. Endoscopic stents can treat most early LSG leaks, but is not as effective for chronic LSG leaks/fistulae. The surgical options to treat a chronic leak/fistula after LSG are laparoscopic Roux en Y esophago-jejunostomy (LRYEJ) or laparoscopic Roux en Y fistulo-jejunostomy.
We reviewed our prospective database for all patients with leak after LSG treated with LRYEJ. We have described our algorithm for managing LSG previously. We prefer to optimize the nutritional status of patients with enteral rather than parenteral nutrition and drain all collections prior to LRYEJ.
We have treated four patients utilizing our technique of LRYEJ. Initial endoscopic stent placement was attempted in all four patients (two failed to resolve (50 %) and two had distal stenosis at the incisura not amenable to endoscopic stenting). We utilized enteral feeding through either naso-jejunal (NJ) or jejunostomy tube feeding in 3/4 (75 %) of patients, and in one patient with stenosis, we could not introduce a NJ tube endoscopically due to tight stricture. This patient was placed on total parenteral nutrition (TPN) and went on to develop pulmonary embolism. None of the patient developed leak after LRYEJ. The only patient with stenosis (25 %) had antecolic LRYEJ. In contrast, all patients who had retrocolic LRYGB laparoscopically did not develop stenosis.
Laparoscopic Roux en Y esophago-jejunostomy for chronic leak/fistula after is safe and effective. Preoperative enteral nutrition is important.
腹腔镜袖状胃切除术（LSG）后发生渗漏是最严重且极具破坏性的并发症之一。内镜支架可治疗大多数早期LSG渗漏，但对慢性LSG渗漏/瘘管的治疗效果不佳。治疗LSG后慢性渗漏/瘘管的手术选择是腹腔镜Roux-en-Y食管空肠吻合术（LRYEJ）或腹腔镜Roux-en-Y瘘管空肠吻合术。
我们回顾了接受LRYEJ治疗的所有LSG术后渗漏患者的前瞻性数据库。我们之前已描述过管理LSG的算法。我们更倾向于通过肠内营养而非肠外营养来优化患者的营养状况，并在进行LRYEJ之前引流所有积液。
我们采用LRYEJ技术治疗了4例患者。所有4例患者均尝试了初始内镜支架置入（2例未解决（50%），2例在切迹处有远端狭窄，不适合内镜支架置入）。3/4（75%）的患者通过鼻空肠（NJ）或空肠造口管进行肠内喂养，在1例有狭窄的患者中，由于狭窄紧密，我们无法在内镜下插入NJ管。该患者接受了全肠外营养（TPN），并继而发生了肺栓塞。LRYEJ术后所有患者均未发生渗漏。唯一有狭窄的患者（25%）接受了结肠前LRYEJ。相比之下，所有接受腹腔镜结肠后LRYGB的患者均未发生狭窄。
腹腔镜Roux-en-Y食管空肠吻合术治疗慢性渗漏/瘘管安全有效。术前肠内营养很重要。
