Department of Surgery, Brookdale University Hospital and Medical Center, Brooklyn, New York, USA.
Division of Metabolic, Endocrine and Minimally Invasive Surgery, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Laparoendosc Adv Surg Tech A. 2020 Sep;30(9):1013-1017. doi: 10.1089/lap.2020.0237. Epub 2020 Jun 18.
Laparoscopic sleeve gastrectomy (LSG) is the most commonly performed bariatric procedure in the United States. Postoperative migration of the stomach into the chest is a rare complication of this procedure. In this study, we present a compilation of acute and chronic intrathoracic sleeve migrations (ITSMs) after LSG and present possible underlying mechanisms of this complication, as described in the literature. We retrospectively reviewed the preoperative, intraoperative, and postoperative course of patients who had an ITSM after LSG between 2011 and 2019. Two patients presented with this complication in the acute setting, whereas 3 patients developed ITSM as a chronic issue years after the primary procedure. All 5 were female patients, with a mean age and body mass index of 55.6 ± 9.5 (years) and 37.8 ± 2.9 kg/m, respectively. None of the cases had a hiatal hernia repair during the initial operation. All cases were completed laparoscopically with reduction of the migrated sleeve into the abdomen and primary hiatal hernia repair. One case required a return to the operating room for an acute reherniation. In this article, we report a compilation of cases of ITSMs after LSG with distinct clinical features that highlight the diversity of possible reasons and risk factors for its development.
腹腔镜袖状胃切除术（LSG）是美国最常进行的减肥手术。胃术后迁移到胸腔是该手术的罕见并发症。在本研究中，我们汇集了 LSG 后急性和慢性胸腔内袖套迁移（ITSM）的病例，并根据文献描述提出了这种并发症的可能潜在机制。我们回顾性分析了 2011 年至 2019 年间接受 LSG 后发生 ITSM 的患者的术前、术中及术后病程。两名患者在急性情况下出现这种并发症，而 3 名患者在初次手术后多年出现 ITSM 这一慢性问题。所有 5 名患者均为女性，平均年龄和体重指数分别为 55.6±9.5（岁）和 37.8±2.9kg/m2。初次手术时均未行食管裂孔疝修补术。所有病例均经腹腔镜完成，将迁移的袖套复位至腹部并进行原发性食管裂孔疝修补。1 例因急性疝复发需要再次手术。在本文中，我们报告了 LSG 后 ITSM 的病例汇编，这些病例具有不同的临床特征，突出了其发展的可能原因和危险因素的多样性。
