Department of Surgery, Queen's University, Kingston, Ontario, Canada.
Department of Surgery, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada.
Surg Obes Relat Dis. 2019 Mar;15(3):424-430. doi: 10.1016/j.soard.2018.12.036. Epub 2019 Jan 11.
An incidental finding of intestinal nonrotation at the time of bariatric surgery poses the following 2 dilemmas: (1) which operation to perform, and (2) whether an appendectomy should be performed concurrently.
To review the experience of 2 Bariatric Centers of Excellence with laparoscopic sleeve gastrectomy (LSG) in patients with intestinal nonrotation, and to perform a systematic review of the literature on this topic.
Two Bariatric Centers of Excellence as designated by the Ontario Bariatric Network.
A chart review of all LSG cases performed in patients with intestinal nonrotation at 2 centers was performed. A systematic review on performing bariatric surgery in patients with intestinal nonrotation/malrotation was conducted using EMBASE and MEDLINE databases.
Four patients (.4% of all cases) underwent LSG in the setting of intestinal nonrotation. Two patients underwent a concurrent appendectomy. Three patients developed postoperative gastrointestinal reflux disease and 1 patient required conversion to a laparoscopic Roux-en-Y gastric bypass. A total of 12 retrospective studies with 23 patients were included in the systematic review. Nineteen patients underwent Roux-en-Y gastric bypass, 3 patients underwent a duodenal switch, and 1 patient underwent LSG. Nine patients (41%) underwent a concurrent appendectomy. Reasons cited for not performing an appendectomy include not completely understanding the anatomic defect, being surprised by the discovery of nonrotation, no consent for the procedure, and suboptimal trocar placement for an appendectomy.
LSG is a reasonable alternative to laparoscopic Roux-en-Y gastric bypass in patients with intestinal nonrotation. A concurrent appendectomy may not be necessary in the era of modern cross-sectional imaging for diagnosing acute appendicitis.
在减重手术时偶然发现肠旋转不良会带来以下两个困境：（1）选择哪种手术方式，（2）是否同时行阑尾切除术。
回顾两个减重卓越中心采用腹腔镜袖状胃切除术（LSG）治疗肠旋转不良患者的经验，并对该主题的文献进行系统回顾。
由安大略省减重网络指定的两个减重卓越中心。
对两个中心所有肠旋转不良患者行 LSG 的病例进行图表回顾。使用 EMBASE 和 MEDLINE 数据库对肠旋转不良/旋转不良患者行减重手术的相关文献进行系统回顾。
4 例（所有病例的 0.4%）肠旋转不良患者行 LSG，其中 2 例同时行阑尾切除术。3 例患者术后发生胃食管反流病，1 例患者需转为腹腔镜 Roux-en-Y 胃旁路术。系统回顾共纳入 12 项回顾性研究，共 23 例患者。19 例行 Roux-en-Y 胃旁路术，3 例行十二指肠转位术，1 例行 LSG。9 例（41%）患者同时行阑尾切除术。未行阑尾切除术的原因包括不完全了解解剖缺陷、意外发现旋转不良、患者不同意手术、以及Trocar 放置不利于行阑尾切除术。
肠旋转不良患者行 LSG 是腹腔镜 Roux-en-Y 胃旁路术的合理替代方案。在现代横断面成像用于诊断急性阑尾炎的时代，阑尾切除术可能并非必需。
