Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Via Pansini 5, 80100, Naples, Italy.
Updates Surg. 2021 Apr;73(2):679-685. doi: 10.1007/s13304-021-00975-y. Epub 2021 Jan 26.
Stapler-less laparoscopic sleeve gastrectomy (LSG) is emerging as a new potential affordable cost-effective alternative procedure. However, no pre-clinical data are currently available on human tissue. We aimed to evaluate whether traditionally suturing without the use of surgical stapling may produce a comparable bursting pressure on human gastric tissue. A prospective cohort of consecutive patients undergoing LSG was divided in two groups to compare a barbed extra-mucosal running suture (stapler-less) versus a standard stapler line. A burst pressure test was applied to the gastric specimen employing high-resolution manometric catheter. Type, location and features of the leak were described. We enrolled a total of 40 obese patients, 20 patients for each group. Median burst pressures of the stapler-less group resulted statistically significant increased (p < 0.0001) than the one in standard stapler group. In all cases, leak occurred along the surgical closure site independently from the used technique (group 1 vs 2; p = N.S.), more often at the proximal stomach (p < 0.05). In human ex vivo model, traditional surgical suture (i.e. running hand-sewn) produced an effective temporary closure, with superior resistance to increasing volume and pressure. How this may impact on clinical LSG outcomes needs further evaluations and was not the object of this study.
无吻合器腹腔镜袖状胃切除术（LSG）作为一种新的、有潜力的、经济实惠的替代方法正在出现。然而，目前尚无关于人体组织的临床前数据。我们旨在评估传统的无缝线缝合是否可以在人体胃组织上产生相当的爆破压力。一项连续接受 LSG 的前瞻性队列研究患者被分为两组，比较使用带刺的黏膜外连续缝合（无吻合器）与标准吻合器线。对胃标本进行爆破压力测试，使用高分辨率测压导管。描述了泄漏的类型、位置和特征。我们共纳入了 40 例肥胖患者，每组 20 例。无吻合器组的中位爆破压力显著增加（p<0.0001），明显高于标准吻合器组。在所有情况下，泄漏都发生在手术闭合部位，与使用的技术无关（组 1 与组 2；p=无统计学意义），更常见于胃近端（p<0.05）。在人体离体模型中，传统的手术缝合（即连续手工缝合）产生了有效的临时闭合，对增加的容量和压力具有更好的抵抗能力。这对临床 LSG 结果的影响需要进一步评估，而不是本研究的目的。
