Saber Alan A, Shoar Saeed, Khoursheed Mousa
Metabolic and bariatric surgery institute, The Brooklyn Hospital Center, Icahn School of Medicine at Mount Sinai, Brooklyn, NY, USA.
Department of Bariatric Surgery, Kuwait Health Sciences Center, Al Jahra, Kuwait.
Obes Surg. 2017 Aug;27(8):1917-1923. doi: 10.1007/s11695-017-2589-6.
Despite its technical simplicity, laparoscopic sleeve gastrectomy (LSG) complications are increasingly reported. Intra-thoracic sleeve migration (ITSM ) is a rare complication after LSG which has been inconsistently addressed in the literature.
The purpose of this study was to emphasize ITSM occurrence after LSG and evaluate the perioperative factors associated with its development.
Between January and July 2016, LSG patients diagnosed with ITSM at two bariatric surgery departments were identified. Perioperative factors were assessed for all the patients and compared between two groups, LSG alone and LSG with concomitant hiatal hernia (HH) repair (HHR).
A total of 19 patients (6 males and 13 females) were included. Central obesity was present in 18 patients (94.7%). Nine patients (47.4%) had concomitant hiatal hernia repair during their original LSG. Post-LSG GERD (94.7%) (38.9% de novo and 61.1% recurrent) and post-LSG constipation (57.9%) were commonly associated with ITSM. Severe refractory GERD was the most common presentation for ITSM (94.7%), followed by epigastric pain (47.4%), persistent nausea/vomiting (36.8%), and dysphagia (21.1%). Time interval between primary LSG and ITSM diagnosis ranged from 1 day to 3 years. Patients with LSG and concomitant HHR presented with higher post-LSG BMI compared to the LSG patients (37 ± 6.4 kg/m vs. 30.1 ± 6.3 kg/m, p = 0.03). All the patients underwent successful reduction of ITSM and subsequent HHR.
Central obesity, chronic constipation, post-LSG GERD, and concomitant HHR are commonly seen in post-laparoscopic sleeve gastrectomy intra-thoracic sleeve migration.
尽管腹腔镜袖状胃切除术（LSG）技术操作简单，但相关并发症的报道却日益增多。胸腔内胃袖套移位（ITSM）是LSG术后一种罕见的并发症，文献中对此的论述并不一致。
本研究旨在强调LSG术后ITSM的发生情况，并评估与其发生相关的围手术期因素。
2016年1月至7月期间，在两个减肥手术科室确诊为ITSM的LSG患者被纳入研究。对所有患者的围手术期因素进行评估，并在单纯LSG组和同期行食管裂孔疝（HH）修补术（HHR）的LSG组之间进行比较。
共纳入19例患者（6例男性，13例女性）。18例患者（94.7%）存在中心性肥胖。9例患者（47.4%）在初次LSG手术时同期进行了食管裂孔疝修补术。LSG术后胃食管反流病（GERD）（94.7%）（38.9%为新发，61.1%为复发）和LSG术后便秘（57.9%）与ITSM密切相关。严重难治性GERD是ITSM最常见的表现（94.7%），其次是上腹部疼痛（47.4%）、持续性恶心/呕吐（36.8%）和吞咽困难（21.1%）。初次LSG手术至ITSM诊断的时间间隔为1天至3年。与单纯LSG患者相比，行LSG并同期HHR的患者术后BMI更高（分别为37±6.4kg/m²和30.1±6.3kg/m²，p=0.03）。所有患者的ITSM均成功复位并随后进行了HHR。
中心性肥胖、慢性便秘、LSG术后GERD以及同期HHR在腹腔镜袖状胃切除术后胸腔内胃袖套移位患者中较为常见。
