Guerrier Jean B, Mehaffey James H, Schirmer Bruce D, Hallowell Peter T
Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
Am Surg. 2018 May 1;84(5):690-694.
Laparoscopic sleeve gastrectomy (LSG) is a well-established treatment for morbid obesity. Staple line leak (SLL) remains one of the most serious and life-threatening complications after LSG; however, no consensus exists for prevention. The purpose of this study is to review and compare the different methods of staple line management used at our institution. Retrospective review of preoperative, intraoperative, and postoperative factors was performed for all patients undergoing LSG at a single institution between September 2010 and August 2015. Primary outcome measure was SLL by reinforcement method (none/Seamguard/Oversewing). A total of 256 patients undergoing LSG were included, 197 (76.95%) were women and 233 (87.11%) were whites. The patients had a mean age of 44.64 years and body mass index of 49.24 kg/m-2. Among those patients, 145 (56.64%) had staple line reinforced with suture (28, 10.94%) or Gore Seamguard (115, 44.92%) and 111 (43.36%) had no reinforcement, with no difference in baseline factors between the groups (all P > 0.05). Gastric leaks were identified in nine patients (3.52%) with no difference between reinforcement (2.7 vs 2.1%, P = 0.54) or leak test method (air vs methylene blue). However, oversewing the staple line was associated with higher incidence of stenosis (P < 0.01). SLL after LSG is a serious complication with significant morbidity and mortality. This study demonstrated that staple line reinforcement does not provide significant leak reduction but does reduce intraoperative staple line bleeding. In addition, oversewing the staple line was associated with postoperative sleeve stenosis without added benefits.
腹腔镜袖状胃切除术（LSG）是一种成熟的治疗病态肥胖症的方法。吻合口漏（SLL）仍然是LSG术后最严重且危及生命的并发症之一；然而，在预防方面尚未达成共识。本研究的目的是回顾和比较我们机构使用的不同吻合口处理方法。对2010年9月至2015年8月在单一机构接受LSG的所有患者的术前、术中和术后因素进行回顾性分析。主要结局指标是通过加固方法（无/Seamguard/缝合）判断的吻合口漏。共纳入256例行LSG的患者，其中197例（76.95%）为女性，233例（87.11%）为白人。患者的平均年龄为44.64岁，体重指数为49.24kg/m²。在这些患者中，145例（56.64%）的吻合口用缝线加固（28例，10.94%）或使用Gore Seamguard加固（115例，44.92%），111例（43.36%）未进行加固，两组间基线因素无差异（所有P>0.05）。9例患者（3.52%）出现胃漏，加固组（2.7%对2.1%，P=0.54）或漏诊方法（空气对亚甲蓝）之间无差异。然而，缝合吻合口与更高的狭窄发生率相关（P<0.01）。LSG术后的吻合口漏是一种严重并发症，具有显著的发病率和死亡率。本研究表明，吻合口加固并不能显著减少漏出，但确实能减少术中吻合口出血。此外，缝合吻合口与术后袖状胃狭窄相关，且无额外益处。
