Department of Digestive, Oncologic and Metabolic Surgery, Obesity Center, Institut Mutualiste Montsouris, Paris University, 42 Boulevard Jourdan, 75014, Paris, France.
Sorbonne University, Paris, France.
Obes Surg. 2021 Apr;31(4):1541-1548. doi: 10.1007/s11695-020-05156-1. Epub 2021 Jan 26.
Sleeve gastrectomy (SG) is the most common bariatric procedure performed worldwide. However, without a standardised surgical technique, heterogeneous outcomes and complications such as gastro-oesophageal reflux disease (GERD) have been reported. The aim of this study was to identify reproducible anatomical criteria for SG to obtain safe and effective results.
A prospective photographic study that captured every phase of each procedure was completed. The photographic documentation was carefully examined in order to identify anatomical criteria that would help make our technique reproducible. Postsurgical results were reported in terms of complications and mortality, while functional and morphological results were evaluated using 3-month upper gastrointestinal (UGI) series and 12-month computed tomography (CT) scan, respectively. BMI, percentage excess weight loss (%EWL), comorbidities, and GERD symptoms at 12 months were analysed.
One hundred thirty-four consecutive laparoscopic SG were photographed, and four reproducible anatomical criteria were identified: (1) to preserve the gastric antral posterior ligament (GAPL); (2) to dissect the gastro-pancreatic ligament (GPL); (3) to expose the right edge of the left diaphragmatic crus; and (4) to ensure staple-line linearity. No leaks occurred, and only one patient needed relaparoscopy for staple-line hematoma. Mortality and 30-day readmission rates were null. Gastric tube morphologies on the 12-month CT scans were homogeneous. At 12 months, median BMI was 30.8 kg/m [IQR 20-47.2] and mean %EWL was 69.0 ± 24.5%; comorbidities resolved in 65.8-88.1% of patients, and GERD symptoms resolved in 44.4%.
The four anatomical criteria for SG that we propose are safe, effective, and reproducible and have acceptable postsurgical outcomes.
袖状胃切除术（SG）是全球最常见的减重手术。然而，由于缺乏标准化的手术技术，已经报道了各种结果和并发症，如胃食管反流病（GERD）。本研究的目的是确定可重复的 SG 解剖学标准，以获得安全有效的结果。
完成了一项前瞻性摄影研究，该研究记录了每个手术阶段的每一个步骤。仔细检查了摄影记录，以确定有助于使我们的技术可重复的解剖学标准。术后结果报告了并发症和死亡率，而功能和形态学结果则分别通过 3 个月的上消化道（UGI）系列和 12 个月的计算机断层扫描（CT）扫描进行评估。分析了 12 个月时的 BMI、超重减轻百分比（%EWL）、合并症和 GERD 症状。
连续拍摄了 134 例腹腔镜 SG，确定了四个可重复的解剖学标准：（1）保留胃窦后韧带（GAPL）；（2）解剖胃胰韧带（GPL）；（3）暴露左膈肌脚的右侧边缘；和（4）确保吻合线线性。没有发生漏诊，只有 1 例患者需要再次剖腹探查吻合口血肿。死亡率和 30 天再入院率为零。12 个月 CT 扫描的胃管形态均匀。12 个月时，中位数 BMI 为 30.8kg/m [IQR 20-47.2]，平均 %EWL 为 69.0±24.5%；65.8-88.1%的患者合并症得到缓解，44.4%的患者 GERD 症状得到缓解。
我们提出的 SG 四个解剖学标准安全、有效且可重复，术后效果可接受。
