Archid Rami, Bazerbachi Fateh, Abu Dayyeh Barham K, Hönes Felix, Ahmad Suhaib J S, Thiel Karolin, Nadiradze Giorgi, Königsrainer Alfred, Wichmann Dörte
Department for General, Visceral and Transplant Surgery, Eberhard-Karls-University Hospital, Hoppe-Seyler-Str. 3-5, 72076, Tuebingen, Germany.
Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA.
Obes Surg. 2021 Jun;31(6):2511-2519. doi: 10.1007/s11695-021-05287-z. Epub 2021 Mar 1.
Staple line leak (SLL) is a serious complication after sleeve gastrectomy (SG). Common endoscopic treatment options include self-expandable metallic stent (SEMS), endoscopic internal drainage (EID), and endoscopic closure. The endoscopic negative pressure therapy (ENPT) is a promising treatment option combining temporary sealing of the defect with drainage of the inflammatory bed. In this study, we compare the outcome of ENPT and SEMS for the treatment of SLL following SG.
A retrospective cohort of 27 patients (21 females) treated at a single center for SLL after SG was included. ENPT was primary therapy for 14 patients and compared with 13 patients treated primarily using SEMS.
ENPT was associated with a significant reduction of hospital stay (19 ± 15.1 vs. 56.69 ± 47.21 days, p = 0.027), reduced duration of endoscopic treatment (9.8 ± 8.6 vs. 44.92 ± 60.98 days, p = 0.009), and shorter transabdominal drain dwell time (15 (5-96) vs. 45 (12-162) days, p = 0.014) when compared to SEMS. Whereas endoscopic management was successful in 12/14 (85.7%) of patients from the ENPT group, SEMS was successful in only 5/13 (38.5%) of patients (p = 0.015). Furthermore, ENPT was associated with a significant reduction of endoscopic adverse events compared with SEMS (14.3% vs. 76.92% p = 0.001).
Compared with SEMS, ENPT is effective and safe in treating SLL after SG providing higher success rates, shorter treatment duration, and lower adverse events rates.
吻合口漏是袖状胃切除术后的一种严重并发症。常见的内镜治疗方法包括自膨式金属支架置入、内镜下内引流及内镜下闭合术。内镜下负压治疗是一种很有前景的治疗方法，它能暂时封闭缺损并引流炎症床。在本研究中，我们比较了内镜下负压治疗与自膨式金属支架置入治疗袖状胃切除术后吻合口漏的疗效。
纳入在单一中心接受袖状胃切除术后吻合口漏治疗的27例患者（21例女性）的回顾性队列研究。14例患者以内镜下负压治疗作为主要治疗方法，并与13例主要采用自膨式金属支架置入治疗的患者进行比较。
与自膨式金属支架置入相比，内镜下负压治疗可显著缩短住院时间（19±15.1天 vs. 56.69±47.21天，p = 0.027）、内镜治疗时间（9.8±8.6天 vs. 44.92±60.98天，p =
0.009）及经腹引流管留置时间（15（5 - 96）天 vs. 45（12 - 162）天，p = 0.014）。内镜下负压治疗组12/14（85.7%）的患者内镜治疗成功，而自膨式金属支架置入组仅5/13（38.5%）的患者成功（p = 0.015）。此外，与自膨式金属支架置入相比，内镜下负压治疗的内镜不良事件显著减少（14.3% vs. 76.92%，p = 0.001）。
与自膨式金属支架置入相比，内镜下负压治疗在治疗袖状胃切除术后吻合口漏方面有效且安全，成功率更高、治疗时间更短且不良事件发生率更低。
