Sousa Patricia, Noronha Ferreira Carlos, Coutinho João, Carepa Fátima, Rosa Rosário, Barão Andreia, Marques Ferreira Carlos, Girao José, Ruivo António, Bicha Castelo Henrique, Lopes João, Almeida Amélia, Carrilho Ribeiro Luís, Velosa José
Serviço de Gastrenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
Serviço de Cirurgia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
GE Port J Gastroenterol. 2019 Jul;26(4):242-250. doi: 10.1159/000492637. Epub 2018 Sep 28.
Laparoscopic sleeve gastrectomy (LSG)-related fistulas are important and potentially fatal complications. We aimed at determining the incidence, predictive factors, and management of recurrence of post-LSG fistulas.
This is a retrospective cohort study of 12 consecutive patients with LSG fistulas managed endoscopically between 2008 and 2013. We analyzed factors associated with recurrence of post-LSG fistulas and the efficacy of a primarily endoscopic approach to manage fistula recurrence.
The average age at fistula detection after LSG was 43.3 ± 10.9 years, and 10 (83%) patients were female. The median interval between surgery and initial fistula detection was 14 (4-145) days. Fistulas were located at the gastric cardia in 9/12 patients. A median of 4 (1-10) endoscopies were performed per patient until all fistulas were successfully closed. The median follow-up was 30.5 (15-72) months. Fistula recurrence was detected in 3 (25%) female patients with an average age of 31.7 ± 7.9 years after a median of 119 (50-205) days of the initial fistula closure. Fistulas in all 3 patients recurred at the gastric cardia and were successfully managed endoscopically. There was a second recurrence in 1 patient after 6 months, and she was re-operated with anastomosis of a jejunal loop at the site of the fistula orifice at the gastric cardia. We did not find any factors at initial fistula detection that were significantly associated with fistula recurrence. There were no deaths related to initial fistula after LSG and fistula recurrence.
A primarily endoscopic approach is an effective and safe method for the management of fistulas after LSG. Fistula recurrence occurred in 25% of patients and was managed endoscopically.
Although we could not define predictive factors of post-LSG fistula recurrence, it is a clinical reality and can be managed endoscopically.
腹腔镜袖状胃切除术（LSG）相关瘘是重要且可能致命的并发症。我们旨在确定LSG术后瘘的发生率、预测因素及复发的处理方法。
这是一项对2008年至2013年间连续12例接受内镜治疗的LSG瘘患者的回顾性队列研究。我们分析了与LSG术后瘘复发相关的因素以及内镜为主的方法处理瘘复发的疗效。
LSG术后发现瘘时的平均年龄为43.3±10.9岁，10例（83%）患者为女性。手术至首次发现瘘的中位间隔时间为14（4 - 145）天。12例患者中有9例瘘位于胃贲门部。每位患者平均进行4（1 - 10）次内镜检查直至所有瘘成功闭合。中位随访时间为30.5（15 - 72）个月。3例（25%）女性患者在首次瘘闭合中位时间119（50 - 205）天后出现瘘复发，平均年龄为31.7±7.9岁。所有3例患者的瘘均在胃贲门部复发，并通过内镜成功处理。1例患者在6个月后出现第二次复发，她在胃贲门部瘘口处接受了空肠袢吻合的再次手术。我们在首次发现瘘时未发现任何与瘘复发显著相关的因素。LSG术后首次瘘及瘘复发均无相关死亡病例。
内镜为主的方法是处理LSG术后瘘的有效且安全的方法。25%的患者出现瘘复发，可通过内镜处理。
尽管我们无法确定LSG术后瘘复发的预测因素，但这是临床现实且可通过内镜处理。
