Cheng Qiuye, Tree Kevin, Edye Michael, Devadas Michael
Department of Surgery, Blacktown Hospital, Australia; Discipline of Surgery, University of Western Sydney, Australia.
Department of Surgery, Blacktown Hospital, Australia.
Int J Surg Case Rep. 2020;68:180-184. doi: 10.1016/j.ijscr.2020.02.060. Epub 2020 Feb 29.
With the advent of more minimally invasive procedures like endoscopic sleeve gastroplasty (ESG) for weight loss and metabolic disorders, we are seeing more cases of patients presenting with sub-optimal results for consideration of alternative weight loss surgery. The report aims to describe our experience in converting ESG to laparoscopic sleeve gastrectomy and highlight our suggested technique, challenges and pitfalls.
We described two bariatrics cases detailing our findings on initial endoscopy along with methods used to reverse ESG hardware, followed by issues encountered during sleeve gastrectomy 1 month later. Case 1 being of a 33 year old female (BMI - 50.7) with previous laparoscopic band removal and 2 ESG attempts, while case 2 is a 31 year old female (BMI 44.6) with previously failed gastric balloon and ESG.
ESG reversal was performed without difficulty via endoscopy with visible sutures cut and hardware removed with snares. In both cases, the stomach was easily endoscopically distensible. During sleeve gastrectomy, extra-gastric adhesions along with more gastro-gastric sutures were encountered in case 1. In case 2, ESG hardware was noted on the external surface of stomach with misfiring of 3rd stapler reload during sleeve gastrectomy likely related to unidentified retained hardware. No post-operative complications occurred in either of the cases with adequate weight loss on one month follow up.
In our experience, ESG conversion to sleeve gastrectomy is feasible and for the most part, uncomplicated. In our case series, we described a two staged approach to conversion although a single staged conversion is theoretically feasible.
随着诸如内镜袖状胃成形术（ESG）等更多微创减肥和代谢紊乱手术的出现，我们看到越来越多患者的手术效果不理想，需要考虑其他减肥手术。本报告旨在描述我们将ESG转换为腹腔镜袖状胃切除术的经验，并强调我们建议的技术、挑战和陷阱。
我们描述了两例肥胖症病例，详细说明了我们在初次内镜检查中的发现，以及用于拆除ESG硬件的方法，随后介绍了1个月后袖状胃切除术中遇到的问题。病例1是一名33岁女性（BMI - 50.7），曾接受腹腔镜束带拆除术并尝试过2次ESG；病例2是一名31岁女性（BMI 44.6），曾接受胃内球囊植入术和ESG但均失败。
通过内镜轻松进行了ESG逆转，可见缝线被切断，硬件用圈套器移除。在两例病例中，胃在内镜下都易于扩张。在病例1的袖状胃切除术中，遇到了胃外粘连以及更多的胃胃缝合。在病例2中，在胃外表面发现了ESG硬件，袖状胃切除术中第3个吻合器重新装填时出现失误，可能与未识别的残留硬件有关。两例病例均未发生术后并发症，术后1个月随访时体重均有适当减轻。
根据我们的经验，将ESG转换为袖状胃切除术是可行的，并且在大多数情况下并不复杂。在我们的病例系列中，我们描述了一种两阶段的转换方法，尽管理论上单一阶段的转换也是可行的。
