Lewis Cameron S, Varma Aditya K, Hamdorf Jeffrey M
Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Australia.
Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Crawley, Australia.
Surg Obes Relat Dis. 2016 Jun;12(5):976-983. doi: 10.1016/j.soard.2015.12.014. Epub 2015 Dec 10.
Laparoscopic sleeve gastrectomy (LSG) is becoming increasingly popular. With significant failure rates for laparoscopic adjustable gastric banding (LAGB), conversion to LSG is an attractive consideration for maintenance of target percentage excess weight loss (%EWL). Conversions can be successfully achieved in either 1-stage (OS) or 2-stage (TS) surgery.
We intend to examine safety between OS and TS surgery and determine features indicative for OS surgery.
Records were audited from the database of a private surgical practice located in Perth, Western Australia.
We analyzed 86 patients in a prospective observational study over a 3-year time frame (38 OS, 48 TS). The primary outcome was perioperative events, graded using the Clavien-Dindo classification system. Secondary outcomes included any preoperative, intraoperative, and postoperative events.
Surgical complications were similar between OS and TS groups. Grades of complications were not significantly different. No difference was found in procedural normality between cohorts (P = .95). More adhesions were present in the TS group compared with the OS group after accounting for adjustments (P = .05). Patient demographic characteristics were not different between groups, with the exception of body mass index (BMI). There were no staple line leaks within the OS group; 2 leaks occurred in the TS group.
OS surgery appears as safe as TS surgery provided surgeons carefully assess patient eligibility. We recommend the following features for ideal OS candidacy: no previous band complications, minimal peritoneal adhesions under laparoscopy, minimal co-morbidities, and a lower BMI at entry into conversion.
腹腔镜袖状胃切除术（LSG）越来越受欢迎。由于腹腔镜可调节胃束带术（LAGB）的失败率较高，因此转换为LSG是维持目标超重减轻百分比（%EWL）的一个有吸引力的考虑因素。转换手术可以通过一期（OS）或二期（TS）手术成功完成。
我们旨在研究OS手术和TS手术的安全性，并确定提示OS手术的特征。
从位于西澳大利亚珀斯的一家私人外科诊所的数据库中审核记录。
我们在一项为期3年的前瞻性观察研究中分析了86例患者（38例OS手术，48例TS手术）。主要结局是围手术期事件，使用Clavien-Dindo分类系统进行分级。次要结局包括任何术前、术中和术后事件。
OS组和TS组的手术并发症相似。并发症等级无显著差异。队列之间在手术正常性方面未发现差异（P = 0.95）。经过调整后，TS组比OS组存在更多粘连（P = 0.05）。除体重指数（BMI）外，两组患者的人口统计学特征无差异。OS组未发生吻合口漏；TS组发生了2例漏。
如果外科医生仔细评估患者的适用性，OS手术似乎与TS手术一样安全。我们推荐以下特征作为理想的OS手术候选条件：既往无束带并发症、腹腔镜下腹膜粘连最少、合并症最少以及转换手术时BMI较低。
