Department of General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel); Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel (Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel).
Department of General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel (Affiliated to the Faculty of Health and Science, Ben-Gurion University, Beer-Sheba, Israel).
Surg Obes Relat Dis. 2020 Dec;16(12):1893-1900. doi: 10.1016/j.soard.2020.07.035. Epub 2020 Aug 14.
Staple-line leaks (SLL) after sleeve gastrectomy (SG) are a rare but serious complication requiring radiologic and endoscopic interventions with varying degrees of success. When failed, a chronic gastrocutaneous fistula forms with decreasing chances of closure with time. Definitive surgical management of chronic SLL after SG include laparoscopic revision to total/subtotal gastrectomy (LTG/LSTG) or a fistulo-jejunostomy (LRYFJ), both with Roux-en-Y reconstruction.
Comparison of SG revisions to LTG/LSTG versus LRYFJ as a definitive treatment for chronic SLL.
High-volume bariatric unit.
Retrospective review of a prospectively maintained database identified 17 patients with chronic gastric fistula after SG that were revised to either LTG/LSTG or LRYFJ between September 2011 and May 2020. Demographic characteristics, clinical data, quality of life, and laboratory values for both options were compared.
Of the 17 conversions, 8 were revised to LTG/LSTG and 9 to LRYFJ. Mean age and body mass index at revision were 36.85 years (range, 21-66 yr) and 29 kg/m (range, 21-36 kg/m), respectively. Average preoperative endoscopic attempts was 5 (range, 1-16). The overall average operation time of revision was 183 minutes (range, 130-275 min) with no significant difference between either conversion options. Mean follow-up time was 46.5 months (range, 1-81 mo) and was available for 10 patients (58.8%). Food intolerance was significantly better after revision to LRYFJ (n = 6/6, 100% versus n = 1/5, 20%, P < .05). There were no significant differences between revisional procedures and laboratory abnormalities.
Laparoscopic revision to LRYFJ is a safe and feasible treatment for chronic SLL.
袖状胃切除术（SG）后吻合口渗漏（SLL）是一种罕见但严重的并发症，需要放射和内镜介入治疗，成功率各不相同。失败时，随着时间的推移，会形成慢性经皮瘘，其闭合的可能性逐渐降低。SG 后慢性 SLL 的确定性手术治疗包括腹腔镜修正为全胃/次全胃切除术（LTG/LSTG）或瘘管空肠吻合术（LRYFJ），两者均采用 Roux-en-Y 重建。
比较 SG 修正为 LTG/LSTG 与 LRYFJ 作为慢性 SLL 的确定性治疗方法。
大容量减重单位。
回顾性分析 2011 年 9 月至 2020 年 5 月期间，通过前瞻性维护的数据库确定了 17 例因 SG 后慢性胃瘘而行 LTG/LSTG 或 LRYFJ 修正的患者。比较两种选择的人口统计学特征、临床数据、生活质量和实验室值。
17 例转化中，8 例修正为 LTG/LSTG，9 例修正为 LRYFJ。修正时的平均年龄和体重指数分别为 36.85 岁（范围，21-66 岁）和 29kg/m（范围，21-36kg/m）。术前内镜尝试的平均次数为 5 次（范围，1-16 次）。两种转换方式的手术总时间平均为 183 分钟（范围，130-275 分钟），无显著差异。平均随访时间为 46.5 个月（范围，1-81 个月），10 例（58.8%）可获得随访。LRYFJ 修正后食物不耐受明显改善（n=6/6，100%与 n=1/5，20%，P<.05）。两种修正术之间无明显差异，实验室异常也无明显差异。
腹腔镜修正为 LRYFJ 是治疗慢性 SLL 的一种安全可行的方法。
