Bingham Jason, Lallemand Michael, Barron Morgan, Kuckelman John, Carter Preston, Blair Kelly, Martin Matthew
Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
Department of General Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
Am J Surg. 2016 May;211(5):943-7. doi: 10.1016/j.amjsurg.2016.02.002. Epub 2016 Feb 23.
Staple line leak after sleeve gastrectomy (SG) is a rare but dreaded complication with a reported incidence of 0% to 8%. Many surgeons routinely test the staple line with an intraoperative leak test (IOLT), but there is little evidence to validate this practice. In fact, there is a theoretical concern that the leak test may weaken the staple line and increase the risk of a postop leak.
Retrospective review of all SGs performed over a 7-year period was conducted. Cases were grouped by whether an IOLT was performed, and compared for the incidence of postop staple line leaks. The ability of the IOLT for identifying a staple line defect and for predicting a postoperative leak was analyzed.
Five hundred forty-two SGs were performed between 2007 and 2014. Thirteen patients (2.4%) developed a postop staple line leak. The majority of patients (n = 494, 91%) received an IOLT, including all 13 patients (100%) who developed a subsequent clinical leak. There were no (0%) positive IOLTs and no additional interventions were performed based on the IOLT. The IOLT sensitivity and positive predictive value were both 0%. There was a trend, although not significant, to increase leak rates when a routine IOLT was performed vs no routine IOLT (2.6% vs 0%, P = .6).
The performance of routine IOLT after SG provided no actionable information, and was negative in all patients who developed a postoperative leak. The routine use of an IOLT did not reduce the incidence of postop leak, and in fact was associated with a higher leak rate after SG.
袖状胃切除术后（SG）吻合钉线渗漏是一种罕见但可怕的并发症，报告发生率为0%至8%。许多外科医生常规在术中进行渗漏试验（IOLT）以检测吻合钉线，但几乎没有证据证实这种做法的有效性。事实上，理论上担心渗漏试验可能会削弱吻合钉线并增加术后渗漏的风险。
对7年内所有实施的袖状胃切除术进行回顾性分析。根据是否进行IOLT对病例进行分组，并比较术后吻合钉线渗漏的发生率。分析IOLT识别吻合钉线缺陷和预测术后渗漏的能力。
2007年至2014年间共进行了542例袖状胃切除术。13例患者（2.4%）发生了术后吻合钉线渗漏。大多数患者（n = 494，91%）接受了IOLT，包括所有13例（100%）随后出现临床渗漏的患者。IOLT均未呈阳性，且未基于IOLT进行额外干预。IOLT的敏感性和阳性预测值均为0%。与未进行常规IOLT相比，进行常规IOLT时有增加渗漏率的趋势，尽管不显著（2.6% vs 0%，P = 0.6）。
袖状胃切除术后进行常规IOLT未提供可采取行动的信息，且在所有发生术后渗漏的患者中结果均为阴性。常规使用IOLT并未降低术后渗漏的发生率，实际上与袖状胃切除术后更高的渗漏率相关。
