Department of Digestive, Esogastric, and Bariatric Surgery, Bichat Claude Bernard University Hospital, Paris, France; Université de Paris, Inserm UMR 1149 F-75018 Paris, France.
Department of Digestive Surgery, Amiens University Medical Center, Amiens, France.
Surg Obes Relat Dis. 2021 May;17(5):947-955. doi: 10.1016/j.soard.2021.01.023. Epub 2021 Jan 29.
Gastric leak (GL) is the most highly feared early postoperative complication after sleeve gastrectomy (SG), with an incidence of 1% to 2%. This complication may require further surgery/endoscopy, with a risk of management failure that may require additional surgery, including total gastrectomy, leading to a risk of mortality of 0% to 9%.
Assess the impact of factors that may lead to a poorer evolution of GL.
University Hospital, France, public practice.
This was a retrospective, single-center study of a group of patients managed for GL after SG between November 2004 and January 2019 (n = 166). Forty-three patients were excluded. The population study was divided into 2 groups: patients with easy closing of the GL (n = 73) and patients with difficult closing of the GL or failure to heal (n = 50). Patients were allocated to 1 of 2 groups depending on the time to heal (median time of 84 days). The study's primary efficacy endpoint was to determine the risk factors for a poorer evolution of GL.
Among 123 patients included in this study, 103 patients had undergone primary SG (83.7%). The mean time to the appearance of GL was 15.1 days (range, 1-156 d). Seventy-four patients underwent a reoperation (60%). The mean number of endoscopies per patient was 2.7 (range, 2-7 endoscopies). The mean time to healing was 89.5 days (range, 18-386 d). There were 8 cases of healing failure (6.5%). Multivariate analysis identified body mass index (>47 kg/m), time to referral (>2 d), and serum prealbumin level (<.1 g/dL) to be independent risk factors for a poorer evolution of GL.
Improvement of nutritional status before SG and early referral for GL could reduce the risk of delayed closure or the need for further surgery.
胃漏（GL）是袖状胃切除术（SG）后最令人担忧的早期术后并发症，发生率为 1%至 2%。这种并发症可能需要进一步的手术/内镜治疗，存在治疗失败的风险，可能需要额外的手术，包括全胃切除术，导致死亡率为 0%至 9%。
评估可能导致 GL 恶化的因素的影响。
法国大学医院，公共实践。
这是一项回顾性的单中心研究，对 2004 年 11 月至 2019 年 1 月期间接受 SG 后 GL 治疗的一组患者（n=166）进行了研究。排除了 43 例患者。人群研究分为两组：GL 易于闭合的患者（n=73）和 GL 难以闭合或愈合不良的患者（n=50）。根据愈合时间（中位数时间为 84 天）将患者分配到 1 组或 2 组。研究的主要疗效终点是确定 GL 恶化的风险因素。
在这项研究中，123 例患者中，103 例患者接受了原发性 SG（83.7%）。GL 出现的平均时间为 15.1 天（范围，1-156 天）。74 例患者接受了再次手术（60%）。每位患者的内镜检查次数平均为 2.7 次（范围，2-7 次）。平均愈合时间为 89.5 天（范围，18-386 天）。有 8 例愈合失败（6.5%）。多变量分析确定体重指数（>47kg/m）、转诊时间（>2 天）和血清前白蛋白水平（<.1g/dL）是 GL 恶化的独立危险因素。
SG 前改善营养状况和早期转诊治疗 GL 可降低延迟闭合或需要进一步手术的风险。
