Department of Surgery/ Bariatric Division, University Hospitals, Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH, 44121, USA.
Department of Surgery, Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX, USA.
Obes Surg. 2018 Jun;28(6):1731-1737. doi: 10.1007/s11695-017-3087-6.
Sleeve gastrectomy (SG) is one of the most common procedures performed for weight loss. Many seek the "perfect sleeve" with the notion that the type of calibrating device affects sleeve shape, and this in turn will affect outcomes and complications. Two major concerns after SG are amount of weight loss and acid reflux. Our aim was to determine if the various calibration methods could impact sleeve shape and thereby allow for better outcomes of weight loss and reflux.
A retrospective chart review was performed of 210 patients who underwent SG and had postoperative upper gastrointestinal (UGI) study from 2011 to 2015 in a single center by a single (fellowship-trained) bariatric surgeon. Data regarding demographics, calibrating devices and clinical outcomes at 1 year (weight loss and de novo acid reflux) were collected. UGIs were reviewed by two radiologists blinded to the clinical outcomes. Sleeve shape was classified according to a previously described classification as tubular, dumbbell, upper pouch, or lower pouch. The types of calibrating devices used to guide the sleeve size intraoperatively were endoscopy, large-bore orogastric tube, and fenestrated suction tube.
One hundred ninety-nine patients met inclusion criteria (11 had no esophagram). Demographics revealed age 45.76 ± 10.6 years, BMI 47 ± 8.6 kg/m, and 82% female. Calibration devices used were endoscopic guidance (7.6%), large bore orogastric tube (41.4%), and fenestrated suction tube (50.5%). Sleeve shape was reported as 32.6% tubular, 20.6% dumbbell, 39.2% lower pouch, and 7.5% upper pouch (100% interrater reliability). No correlation was seen with type of calibration used. Of patients, 62.0% had > 50% excess weight loss at 1 year. Twenty-three percent of patients remained on PPI at 1 year (of which 43.3% did not have reflux preoperatively). The lower pouch shape showed a trend toward less reflux and more weight loss.
This study showed no clear association between uniformity of sleeve shape and the type of calibration device used. The study showed a trend toward decreased reflux and improved weight loss with the lower pouch shape, regardless of calibration device.
袖状胃切除术（SG）是最常见的减肥手术之一。许多人都希望找到“完美的袖套”，他们认为校准装置的类型会影响袖套的形状，而这反过来又会影响手术效果和并发症。SG 术后的两个主要关注点是减重和胃酸反流。我们的目的是确定各种校准方法是否会影响袖套的形状，从而改善减重和反流的效果。
我们对 2011 年至 2015 年在一家中心由同一位（经过 fellowship 培训的）减重外科医生进行的 210 例 SG 术后上消化道（UGI）研究的患者进行了回顾性图表审查。收集了人口统计学数据、校准装置以及术后 1 年的临床结果（减重和新发胃酸反流）。UGI 由两位对临床结果不知情的放射科医生进行审查。袖套形状根据先前描述的分类标准分为管状、哑铃形、上部囊袋或下部囊袋。术中指导袖套大小的校准装置包括内镜、大口径经口胃管和带孔吸引管。
199 例患者符合纳入标准（11 例无食管造影）。人口统计学数据显示，年龄为 45.76±10.6 岁，BMI 为 47±8.6kg/m，女性占 82%。使用的校准装置为内镜引导（7.6%）、大口径经口胃管（41.4%）和带孔吸引管（50.5%）。报告的袖套形状为 32.6%管状、20.6%哑铃形、39.2%下部囊袋和 7.5%上部囊袋（100%组内可靠性）。未发现与使用的校准类型有相关性。术后 1 年，62.0%的患者体重减轻超过 50%。术后 1 年仍有 23%的患者服用 PPI（其中 43.3%术前无反流）。下部囊袋形状与反流减少和减重增加呈趋势相关。
本研究表明，袖套形状的均匀性与使用的校准装置之间没有明显关联。研究表明，无论使用哪种校准装置，下部囊袋形状都与反流减少和减重增加呈趋势相关。
