免钉合腹腔镜袖状胃切除术：原理与技术见解
Stapleless Laparoscopic Sleeve Gastrectomy: Reasoning and Technical Insights.
作者信息
Catanzano Matteo, Grundy Lisa, Bekheit Mohamed
机构信息
Department of Surgery, Aberdeen Royal Infirmary, Foresterhill Health Campus, Aberdeen, AB252ZN, UK.
Department of Surgery, El kabbary General Hospital, Alexandria, Egypt.
出版信息
Obes Surg. 2018 Mar;28(3):854-861. doi: 10.1007/s11695-017-3058-y.
BACKGROUND
Laparoscopic sleeve gastrectomy (LSG) with staple line reinforcement (SLR) is a popular and safe treatment option for morbid obesity. We have developed, devised, and described our own method of stapleless laparoscopic sleeve gastrectomy, which in our limited study appeared safe, efficacious, and potentially cost-effective.
METHODS
We analyzed the outcome of our modified LSG in a case series of three middle-aged women (median age 42 years old). Our main modification was sutured closure of the stomach rather than the commonly utilized technique of stapled closure. Our primary measure of success was the occurrence of post-operative leak. Secondary measures were (a) length of operation, (b) duration of inpatient stay, and (c) percentage of weight loss at 6 and 12 months post operation.
RESULTS
Median operative time = 132 min (120-195 min), and median inpatient stays were 2 days. No post-operative leaks were recorded. The median excess weight loss at 6 months was 39% of initial weight loss and 57.7% at 12 months.
CONCLUSIONS
Stapleless LSG has the potential to be an affordable alternative to the traditional LSG. High-powered studies and a formal cost analysis are required.
背景
带吻合线加固（SLR）的腹腔镜袖状胃切除术（LSG）是一种治疗病态肥胖症的常用且安全的方法。我们已研发、设计并描述了自己的无钉合腹腔镜袖状胃切除术方法，在我们的有限研究中，该方法似乎安全、有效且可能具有成本效益。
方法
我们分析了一组3例中年女性（中位年龄42岁）接受改良LSG的结果。我们的主要改良是采用缝合关闭胃，而非常用的钉合关闭技术。我们成功的主要衡量标准是术后渗漏的发生情况。次要衡量标准包括：（a）手术时长，（b）住院时间，以及（c）术后6个月和12个月时的体重减轻百分比。
结果
中位手术时间为132分钟（120 - 195分钟），中位住院时间为2天。未记录到术后渗漏情况。6个月时的中位超重减轻量为初始体重减轻量的39%，12个月时为57.7%。
结论
无钉合LSG有可能成为传统LSG的一种经济实惠的替代方法。需要开展大规模研究和进行正式的成本分析。
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