Osseis Michael, Lazzati Andrea, Salloum Chady, Gavara Concepcion Gomez, Compagnon Philippe, Feray Cyrille, Lim Chetana, Azoulay Daniel
Department of Hepatobiliary and Pancreatic Surgery and Liver Transplantation, Henri Mondor Hospital, 51 Avenue de Lattre de Tassigny, 94010, Creteil, France.
Department of Digestive Surgery, Centre Hospitalier Intercommunal de Créteil, Creteil, France.
Obes Surg. 2018 Jan;28(1):242-248. doi: 10.1007/s11695-017-2843-y.
Knowledge regarding the feasibility and safety of sleeve gastrectomy (SG) in obese liver transplant recipients is scarce. We report our experience of sleeve gastrectomy following liver transplantation (LT).
All patients who had undergone LT and subsequently underwent SG at our institution were retrospectively reviewed. Surgical outcomes, liver and kidney function tests, outcomes of obesity-related comorbidities, and excess weight loss were analyzed.
Between May 2008 and February 2015, six consecutive patients underwent SG after LT. Three procedures (50%) were performed totally by laparoscopy, and three by upfront laparotomy for concomitant incisional hernia complex repair. Within the first 30 days, one complication occurred: early gastric fistula that required multiple endoscopic procedures and re-intervention, followed by death 19 months after SG due to multi-organ failure. Another patient had one late complication: chronic infection on a parietal mesh successfully controlled by mesh removal. Excess weight loss averaged 76% at 2 years with a median BMI of 28 (21-39) kg/m. Median follow-up was 37.2 months (range 13-101 months). Median length of stay was 9 days (range: 6-81 days).
SG is technically feasible after LT and resulted in weight loss without adversely affecting graft function and immunosuppression. However, morbidity and mortality are high.
关于袖状胃切除术（SG）在肥胖肝移植受者中的可行性和安全性的知识匮乏。我们报告了我们在肝移植（LT）后进行袖状胃切除术的经验。
回顾性分析了在我们机构接受LT并随后接受SG的所有患者。分析了手术结果、肝肾功能检查、肥胖相关合并症的结果以及体重减轻情况。
2008年5月至2015年2月期间，6例连续患者在LT后接受了SG。3例手术（50%）完全通过腹腔镜进行，3例通过前期剖腹手术进行，同时修复复杂的切口疝。在术后30天内，发生了1例并发症：早期胃瘘，需要多次内镜手术和再次干预，随后在SG后19个月因多器官衰竭死亡。另1例患者发生了1例晚期并发症：通过移除补片成功控制了腹壁补片上的慢性感染。2年时平均体重减轻76%，中位体重指数为28（21 - 39）kg/m²。中位随访时间为37.2个月（范围13 - 101个月）。中位住院时间为9天（范围：6 - 81天）。
LT后SG在技术上是可行的，并且导致了体重减轻，而没有对移植物功能和免疫抑制产生不利影响。然而，发病率和死亡率很高。
