Frattini Francesco, Delpini Roberto, Inversini Davide, Pappalardo Vincenzo, Rausei Stefano, Carcano Giulio
Department of Surgery, University of Insubria, Varese, Italy.
Surg Technol Int. 2017 Dec 22;31:123-126.
As reported by The International Federation for the Surgery of Obesity (IFSO) worldwide survey on bariatric surgery, sleeve gastrectomy has become the second most performed bariatric/metabolic procedure in the world just after gastric bypass. If we consider complications, despite a recent systematic review and meta-analysis that reported a substantial decrease in sleeve gastrectomy complication rates, leaks after sleeve gastrectomy still rate between 0 and 18%. Unlike the leaks of other types of gastrointestinal surgery, leaks after sleeve gastrectomy are challenging in diagnosis and treatment and can lead to sepsis, multiple organ failure, and even death. A standardized algorithm of diagnosis and management is still lacking. Current classification of gastric leaks is based on the time of onset and clinico-pathological aspects. Nonetheless, none of the largest series in literature report the pathogenesis of gastric leaks. Given this paucity of evidence-based data and the lack of defined guidelines, we try to examine and consider the pathogenetic factors of gastric leak to implement better treatments and predict outcomes.
据国际肥胖症外科联合会（IFSO）关于减肥手术的全球调查报道，袖状胃切除术已成为全球第二大最常施行的减肥/代谢手术，仅次于胃旁路手术。如果考虑并发症，尽管最近一项系统评价和荟萃分析报告称袖状胃切除术的并发症发生率大幅下降，但袖状胃切除术后的渗漏率仍在0%至18%之间。与其他类型的胃肠手术渗漏不同，袖状胃切除术后的渗漏在诊断和治疗方面具有挑战性，可导致脓毒症、多器官功能衰竭，甚至死亡。目前仍缺乏标准化的诊断和管理算法。目前胃渗漏的分类基于发病时间和临床病理特征。然而，文献中最大的系列研究均未报道胃渗漏的发病机制。鉴于基于证据的数据匮乏且缺乏明确的指南，我们试图研究并考虑胃渗漏的致病因素，以实施更好的治疗并预测预后。
