Division of Bariatric Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Division of Bariatric Surgery, Novant Health UVA Health System Haymarket, Haymarket, VA, 20169, USA.
Obes Surg. 2020 Sep;30(9):3640-3641. doi: 10.1007/s11695-020-04689-9.
Management of the leak is determined by the duration of the leak from the initial surgery. Acute leaks occurring less than 72 hours after surgery are best managed with reoperation and primary repair. Intermediate leaks, greater than 72 hours but less than 12 weeks, can be managed with non-operative management in non-septic patients. When non-operative management fails beyond 12 weeks the leak is considered a chronic fistula which are best treated with definitive operative management. Sub-total gastrectomy with Roux-En-Y reconstruction with gastrojejunostomy, has been reported with resolution of the fistula in over 90% of cases.
To demonstrate the operative management of chronic sleeve gastrectomy leaks.
A 37-year-old male with a history of a sleeve gastrectomy, developed a chronic fistula between the distal gastric staple line and the transverse colon. After non-operative management failed the patient was taken to the operating room for a diagnostic laparoscopy with plans to perform a revision. A fistula between the distal sleeve staple line and the transverse colon was identified. The gastroesophageal junction was dissected and inspected, there was no fistula at the angle of His. A near total gastrectomy was then performed leaving a small gastric pouch. The colonic side of the fistula was oversewn. Roux-En-Y reconstruction was then performed.
No leak identified at four-month follow-up.
Leak after sleeve gastrectomy can be difficult to manage. Chronic leaks do not respond well to non-operative management. Partial gastrectomy with Roux-En-Y reconstruction is a technically challenging option with good results.
漏口的处理取决于初始手术后漏口的持续时间。术后 72 小时内发生的急性漏口最好通过再次手术和初次修复来处理。介于 72 小时至 12 周之间的中期漏口，如果患者没有感染，可以采用非手术方法进行治疗。如果 12 周后非手术治疗失败，漏口就会被认为是慢性瘘管，最好采用确定性手术治疗。胃大部切除术加 Roux-en-Y 重建加胃空肠吻合术已被报道用于治疗超过 90%的瘘管。
展示慢性袖状胃切除术漏口的手术治疗方法。
一位 37 岁的男性，有袖状胃切除术病史，在胃底钉线远端和横结肠之间发生慢性瘘管。在非手术治疗失败后，患者被送往手术室进行诊断性腹腔镜检查，并计划进行修正。发现胃底钉线远端和横结肠之间有瘘管。解剖并检查食管胃结合部，没有在 His 角处发现瘘管。然后进行近全胃切除术，留下一个小的胃囊。缝合结肠侧的瘘口。然后进行 Roux-en-Y 重建。
在四个月的随访中没有发现漏口。
袖状胃切除术后的漏口可能难以处理。慢性漏口对非手术治疗反应不佳。部分胃切除术加 Roux-en-Y 重建是一种技术上具有挑战性的选择，但结果良好。
