Department of Pathology, Korea University Anam Hospital, South Korea University College of Medicine, Seoul, South Korea.
Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
Obes Surg. 2020 Jun;30(6):2140-2146. doi: 10.1007/s11695-020-04439-x.
Sleeve gastrectomy has been considered a primary bariatric surgery; however, surgeons concerned with staple line leakage often query whether staples selected during stomach resection are of an appropriate size. This study aimed to measure gastric wall thickness using pathology laboratory measurements and to identify variables correlated with stomach wall thickness in patients who had undergone laparoscopic sleeve gastrectomy.
We obtained fresh resected stomach wall specimens from 30 patients. Stomach wall thickness was immediately measured postoperatively, comprising the muscle layer of the antrum, body, and fundus. Results were correlated with body mass index (BMI), age, and sex and with diagnoses of presurgical diabetes, hypertension, hyperlipidemia, and fatty liver.
Stomach wall thickness ranged from 3.4 ± 4.3 mm to 1.0 ± 9.6 mm at the antrum. Except for the whole layer at the body wall, there was no significant correlation between wall thickness and other factors. At the body wall, whole layer wall thickness was found to positively correlate with age, sex, diabetes, and smoking (r = 0.469, - 0.391, 0.396, and 0.349, respectively; p < 0.05 in all patients).
Stomach wall thickness varied among patients who had undergone laparoscopic sleeve gastrectomy according to samples taken at three stomach wall sites. The range in wall thickness was normal, and thus, surgeons need not hesitate in selecting the staple height. Also, our study may be helpful to guide surgeon choice concerning the third or fourth staple around the body area when considering a patient's independent factors.
袖状胃切除术已被认为是一种主要的减肥手术；然而，关注吻合口渗漏的外科医生常常质疑胃切除术中选择的吻合钉是否尺寸合适。本研究旨在通过病理实验室测量来测量胃壁厚度，并确定与接受腹腔镜袖状胃切除术患者胃壁厚度相关的变量。
我们从 30 名患者中获得了新鲜的胃壁标本。术后立即测量胃壁厚度，包括胃窦、体和底的肌层。结果与体重指数（BMI）、年龄和性别以及术前糖尿病、高血压、高血脂和脂肪肝的诊断相关。
胃壁厚度在胃窦处为 3.4±4.3mm 至 1.0±9.6mm，体壁除全层外，与其他因素无显著相关性。在体壁，全层壁厚度与年龄、性别、糖尿病和吸烟呈正相关（r=0.469、-0.391、0.396 和 0.349，均为 p<0.05）。
根据胃壁三个部位的标本，接受腹腔镜袖状胃切除术的患者胃壁厚度存在差异。壁厚度范围正常，因此外科医生不必在选择吻合钉高度时犹豫不决。此外，我们的研究可能有助于指导外科医生在考虑患者的独立因素时，选择体区第三或第四排吻合钉。
