Body Science and Metabolic Disorders International Medical Center, China Medical University Hospital, Yude Rd., North Dist, Taichung, Taiwan.
Department of Gastrointestinal Surgery, Zydus Hospitals & Healthcare Research Center, Ahmedabad, India.
Obes Surg. 2020 Aug;30(8):3249-3250. doi: 10.1007/s11695-020-04546-9.
Use of bougie often helps in the calibration of gastric pouch and assess proper closure of the hiatus. Bougie induced esophageal perforation during surgery is uncommon. We encountered a case of bougie induced lower esophageal perforation while introducing it across a gastroesophageal junction.Here we discussed the cause, mechanism of perforation, and its management.
A patient with BMI of 46.7 kg/m 2 was schedule for Laparoscopic Roux- en- Y Gastric Bypass with Hiatus Hernia Repair. A cruroplasty was performed using interrupted non-absorbable suture. Bougie intubation across gastroesophageal junction was unsuccessful after closure of hiatus. Possibilities of incorporation of a esophageal wall during cruroplasty or too tight hiatus was suspected. Crural approximation suture was removed and esophagus was inspected, which showed posterior perforation at the distal esophagus. Primary closure done with fullthickness interrupted 3'0 absorbable suture to create full-thickness interrupted stitches.A Jackson-Pratt drain was placed close to hiatus.
We kept the patient nil per orally for two days.On the fourth postoperative day,the patient recovered uneventfully and was discharge after drain removal.
Bougie induced perforation is uncommon and occurs after improper manipulation of bougie across the gastroesophageal junction. Acute esophageal angulation and over thrusting of the bougie against closed hiatus can contribute to posterior esophageal perforation. Inspection of the esophagus above the hiatus is essential to avoid missed perforation.
使用探条通常有助于校准胃袋并评估裂孔的适当闭合。在手术中，探条引起的食管穿孔并不常见。我们在经胃食管交界处引入探条时遇到了一例下食管穿孔。在这里，我们讨论了穿孔的原因、机制及其处理。
一名 BMI 为 46.7 kg/m 2 的患者计划接受腹腔镜 Roux-en-Y 胃旁路术和裂孔疝修补术。使用间断不可吸收缝线进行横结肠成形术。裂孔关闭后，经胃食管交界处的探条插管不成功。怀疑在横结肠成形术中包含食管壁或裂孔过紧的可能性。拆除近侧吻合缝线并检查食管，显示远端食管后穿孔。用全层间断 3'0 可吸收缝线进行一期缝合，以形成全层间断缝线。在裂孔附近放置 Jackson-Pratt 引流管。
我们让患者禁食两天。术后第四天，患者顺利恢复并在拔除引流管后出院。
探条引起的穿孔并不常见，发生在探条不当穿过胃食管交界处之后。急性食管成角和探条对闭合裂孔的过度推力可导致后食管穿孔。检查裂孔上方的食管对于避免漏诊穿孔至关重要。
