Kirby G C, Macano C A W, Nyasavajjala S M, Sahloul M, Nijjar R, Daskalakis M, Richardson M, Singhal R
Heart of England NHS Foundation Trust, Birmingham Heartlands Campus, Bordesley Green, Birmingham, B9 5SS, UK.
Ann Med Surg (Lond). 2017 Sep 28;23:32-34. doi: 10.1016/j.amsu.2017.09.015. eCollection 2017 Nov.
Leak following bariatric surgery continues to be associated with morbidity and rarely mortality. With improvement in surgical techniques and stapler design, leak rates have reduced drastically. Intra-operative high pressure Methylene blue leak test (HPMB) is one of the techniques employed to confirm integrity of anastomoses and staple lines. Despite this, evidence for its use remains limited. We evaluated the role of HPMB in detecting and preventing leaks.
A retrospective cohort of consecutive patients who underwent primary or revisional Laparoscopic Sleeve Gastrectomy (SG) or Laparoscopic Roux-en-Y Gastric bypass (RYGB) under the care of five surgeons in three centres across Birmingham, UK, between 2012 and 2016 were assessed. All patients had routine HPMB at the end of the procedure. Demographics, HPMB positivity, and post operative leaks were recorded.
924 patients underwent bariatric surgery: 696(75.3%) RYGB, and 225(24.3%) SG. 85(9.2%) were revisional procedures. Two HPMB were positive, which necessitated staple or suture line reinforcement with sutures intra-operatively. The patients had an uneventful recovery. 5 patients had postoperative leaks, all of whom had negative intraoperative HPMB: 3 SG patients; and 2 RYGB patients (gastro-jejunostomy anastomotic leaks). There was no statistically significant relationship between positive HPMB and anastomotic leak (Fishers exact test; p = 1).
Despite routine use of methylene blue dye test in 924 patients, there were only two positive tests. Whilst HPMB may demonstrate technical failure, this study suggests that there is no role for its routine use in primary bariatric surgery. Discontinuation of this practice would reduce risk of anaphylaxis to the dye, cost, and intra-operative time.
减肥手术后的渗漏仍然与发病率相关，很少与死亡率相关。随着手术技术和吻合器设计的改进，渗漏率已大幅降低。术中高压亚甲蓝渗漏试验（HPMB）是用于确认吻合口和钉合线完整性的技术之一。尽管如此，其使用的证据仍然有限。我们评估了HPMB在检测和预防渗漏中的作用。
对2012年至2016年期间在英国伯明翰三个中心的五位外科医生的护理下接受初次或修订腹腔镜袖状胃切除术（SG）或腹腔镜Roux-en-Y胃旁路术（RYGB）的连续患者进行回顾性队列研究。所有患者在手术结束时均进行常规HPMB。记录人口统计学、HPMB阳性情况和术后渗漏情况。
924例患者接受了减肥手术：696例（75.3%）RYGB，225例（24.3%）SG。85例（9.2%）为修订手术。2例HPMB呈阳性，这需要在术中用缝线加固钉合线或缝合线。患者恢复顺利。5例患者术后发生渗漏，所有患者术中HPMB均为阴性：3例SG患者；2例RYGB患者（胃空肠吻合口渗漏）。HPMB阳性与吻合口渗漏之间无统计学显著关系（Fisher精确检验；p = 1）。
尽管在924例患者中常规使用亚甲蓝染色试验，但只有2例呈阳性。虽然HPMB可能显示技术失败，但本研究表明其在原发性减肥手术中的常规使用没有作用。停止这种做法将降低对染料过敏反应的风险、成本和手术时间。
