Boeker Clara, Mall Julian, Reetz Christian, Yamac Kamil, Wilkens Ludwig, Stroh Christine, Koehler Hinrich
Department of General, Visceral, Vascular and Bariatric Surgery, Klinikum Nordstadt, Haltenhoffstr. 41, 30167, Hannover, Germany.
Department of Pathology, Klinikum Nordstadt, Haltenhoffstr. 41, 30167, Hannover, Germany.
Obes Surg. 2017 Dec;27(12):3209-3214. doi: 10.1007/s11695-017-2755-x.
Staple line leakage is a well-known complication after laparoscopic sleeve gastrectomy (LSG). Gastric wall thickness and the staple height may be determining factors for the occurrence of insufficiencies. To investigate this problem, an observational cohort study was carried out. Investigation concentrated on the gastroesophageal junction close to the angle of His, since this area is at highest risk for a leakage.
Fundus wall thickness of 141 specimens after LSG was measured by light microscopy at a predetermined location by a blinded pathologist. Furthermore, fundus wall thickness was compared with demographic data, clinical outcome, and the rate of insufficiencies.
One hundred forty-one patients, 38 male and 103 female undergoing LSG, between January 2014 and July 2015 were included in the study. Male gender was associated with thicker gastric fundus wall. Overall leak rate was 2.1% (3/141). Median wall thickness of the 3 patients with detected leaks in the study group was thinner compared to the non-leak group (2810 vs. 3249 μm, respectively).
DISCUSSION/CONCLUSION: Only male gender correlated with higher wall thickness of the fundus. The fact that all three patients who developed a leak were female, and the fundus of female patients as well as those of the leak group was thinner, indicates that wall thickness may have an impact on the rate of staple line leakage. Further studies with larger patient cohorts are needed.
钉合线渗漏是腹腔镜袖状胃切除术（LSG）后一种众所周知的并发症。胃壁厚度和钉合高度可能是发生渗漏的决定因素。为了研究这个问题，开展了一项观察性队列研究。研究重点关注靠近His角的胃食管交界处，因为该区域发生渗漏的风险最高。
由一位不知情的病理学家在预定位置通过光学显微镜测量141例LSG术后标本的胃底壁厚度。此外，将胃底壁厚度与人口统计学数据、临床结果和渗漏率进行比较。
研究纳入了2014年1月至2015年7月期间接受LSG的141例患者，其中男性38例，女性103例。男性与较厚的胃底壁相关。总体渗漏率为2.1%（3/141）。研究组中3例检测到渗漏的患者的中位壁厚度比无渗漏组薄（分别为2810 vs. 3249μm）。
讨论/结论：只有男性与较厚的胃底壁相关。发生渗漏的3例患者均为女性，且女性患者以及渗漏组患者的胃底较薄，这一事实表明壁厚度可能对钉合线渗漏率有影响。需要对更大的患者队列进行进一步研究。
