Younis Fadi, Shnell Mati, Gluck Nathan, Abu-Abeid Subhi, Eldar Shai, Fishman Sigal
Obesity Service, Department of Gastroenterology and Liver Disease, Tel Aviv Sourasky Medical Center, affiliated with Sackler School of Medicine, Tel Aviv University, 6 Weizmann St, Tel Aviv, Israel.
Bariatric Unit, Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
BMC Surg. 2020 Feb 21;20(1):33. doi: 10.1186/s12893-020-0686-2.
Laparoscopic one anastomosis gastric bypass has become a prominent bariatric procedure. Yet, early and late complications, primarily leaks and strictures, are not uncommon. This study summarizes our experience with endoscopic treatment of laparoscopic one anastomosis gastric bypass complications.
This is a retrospective study of consecutive patients referred to our hospital from 2015 to 2017 with post laparoscopic one anastomosis gastric bypass complications. Therapy was tailored to each case, including fully covered self-expandable metal stents, fibrin glue, septotomy, internal drainage with pigtail stents, through-the-scope and pneumatic dilation. Success was defined as resuming oral nutrition without enteral or parenteral support or further surgical intervention.
Nine patients presented with acute or early leaks: 5 (56%) had staple-line leaks, 3 (33%) had anastomotic leaks and 1 (11%) had both. All were treated with stents. Adjunctive endoscopic drainage was applied in 4 patients (44%). Overall 5 patients (56%) with acute/ early leaks recovered completely, including all 3 patients with anastomotic leak and the patient with both leaks but only 1/5 with staple line leak (20%). Complication rate in the leak group reached 22%. Eight patients presented with strictures, 7 at the anastomosis and one due to remnant stomach misalignment. All anastomotic strictures were dilated successfully. However, the patient with the pouch stricture required conversion to Roux-en-Y gastric bypass after 3 failed attempts of dilation.
Endoscopic treatments of laparoscopic one anastomosis gastric bypass complications are relatively effective and safe. Anastomosis-related complications are more amenable to endoscopic treatment compared to staple line leaks.
腹腔镜单吻合口胃旁路术已成为一种重要的减肥手术。然而，早期和晚期并发症，主要是渗漏和狭窄，并不少见。本研究总结了我们在内镜治疗腹腔镜单吻合口胃旁路术并发症方面的经验。
这是一项对2015年至2017年因腹腔镜单吻合口胃旁路术后并发症转诊至我院的连续患者的回顾性研究。治疗方案根据具体病例量身定制，包括全覆膜自膨式金属支架、纤维蛋白胶、隔膜切开术、猪尾支架内引流、经内镜和气囊扩张术。成功的定义为在无需肠内或肠外支持或进一步手术干预的情况下恢复口服营养。
9例患者出现急性或早期渗漏：5例（56%）为吻合钉线渗漏，3例（33%）为吻合口渗漏，1例（11%）两者均有。所有患者均接受了支架治疗。4例患者（44%）接受了辅助内镜引流。总体而言，5例（56%）急性/早期渗漏患者完全康复，包括所有3例吻合口渗漏患者和1例同时存在两种渗漏的患者，但吻合钉线渗漏患者中只有1/5（20%）康复。渗漏组的并发症发生率达到22%。8例患者出现狭窄，7例发生在吻合口，1例由于残胃错位。所有吻合口狭窄均成功扩张。然而，袋状狭窄患者在3次扩张尝试失败后需要转为Roux-en-Y胃旁路术。
内镜治疗腹腔镜单吻合口胃旁路术并发症相对有效且安全。与吻合钉线渗漏相比，吻合口相关并发症更适合内镜治疗。
