İstanbul Bariatrics, Obesity and Advanced Laparoscopy Center, Hakkı Yeten Cad, Yeşil Çimen Sok, Polat Tower, No:12/407, Şişli, 34394, İstanbul, Turkey.
Department of Radiology, Faculty of Medicine, İstanbul University, Çapa, İstanbul, Turkey.
Langenbecks Arch Surg. 2021 Aug;406(5):1683-1690. doi: 10.1007/s00423-021-02161-5. Epub 2021 Apr 7.
Among various staple-line reinforcement methods applied during sleeve gastrectomy (SG), although data on full-thickness-continuous-suturing (FTCS) is nearly nil, it has been considered as potentially harmful. The safety/efficacy profile of FTCS is assessed.
All consecutive SGs completing 3-month follow-up were studied. Data on peri-operative parameters, complications, and follow-up were prospectively recorded. All reinforcements were completed by FTCS utilizing barbed suture. Super-super obese, secondary SGs, SGs performed in patients with prior anti-reflux surgery, and SGs performed with additional concomitant procedures were evaluated as "technically demanding" SGs. Student's t/chi-square tests were used as appropriate.
Between January 2012 and July 2020, 1008 SGs (941 "primary-standard," 67 "technically demanding") were performed without mortality/venous event. Single leak occurred in a patient with sleeve obstruction (0.1%). Thirteen bleedings, 4 requiring re-surgery (0.4%), and 17 stenoses (1.7%) were encountered. Four stenoses were treated with gastric bypass (1 emergency), 6 by dilatation(s), and one required parenteral nutrition. Six patients with stenosis chose not to have any treatment. No statistically significant difference was observed in postoperative complications between "primary-standard" and "technically demanding" SGs (p > 0.05). The median follow-up was 44 months. The excess weight loss % at 5th year was 80.1%. Suturing added 28.4 ± 6 minutes to the SG, 3 or fewer sutures were used to complete the reinforcement in > 95%. No mishap/complication occurred related to suturing.
FTCS produced excellent result in terms of leakage/hemorrhage with an acceptable stenosis rate at a low cost with half-an-hour increase in the operating time. In contrast to previous allegations, no harm attributable to stitching itself occurred.
在袖状胃切除术（SG）中应用的各种缝线加固方法中，尽管全层连续缝合（FTCS）的数据几乎为零，但它被认为可能有害。评估 FTCS 的安全性/疗效。
研究了所有完成 3 个月随访的连续 SG。前瞻性记录围手术期参数、并发症和随访数据。所有加固均通过带刺缝线完成 FTCS。超级肥胖、二次 SG、在有反流手术史的患者中进行的 SG 以及与其他同时进行的手术的 SG 被评估为“技术要求高”的 SG。使用学生 t 检验/卡方检验。
2012 年 1 月至 2020 年 7 月，1008 例 SG（941 例“原发性标准”，67 例“技术要求高”）无死亡/静脉事件。1 例袖套梗阻患者发生单例漏（0.1%）。发生 13 例出血，4 例需要再次手术（0.4%），17 例狭窄（1.7%）。4 例狭窄采用胃旁路手术治疗（1 例急诊），6 例采用扩张治疗，1 例需要肠外营养。6 例狭窄患者选择不进行任何治疗。“原发性标准”和“技术要求高”SG 术后并发症无统计学差异（p>0.05）。中位随访时间为 44 个月。第 5 年的超重减轻率为 80.1%。缝合增加了 SG 手术 28.4±6 分钟，超过 95%的患者使用 3 根或更少的缝线完成加固。缝合过程中没有发生任何意外/并发症。
FTCS 在漏/出血方面产生了出色的结果，在可接受的狭窄率下，成本低，手术时间仅增加半小时。与之前的指控相反，缝线本身没有造成任何伤害。
