Hojo Yudai, Kurahashi Yasunori, Tomita Toshihiko, Kumamoto Tsutomu, Nakamura Tatsuro, Ishida Yoshinori, Shinohara Hisashi
Division of Upper GI, Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Surg Case Rep. 2021 Sep 16;7(1):207. doi: 10.1186/s40792-021-01293-6.
Gomez gastroplasty, which was developed in the 1970s as one of the gastric restrictive surgeries for severe obesity, partitions the stomach using a stapler from the lesser towards the greater curvature at the upper gastric body, leaving a small channel. This procedure is no longer performed due to poor outcomes, but surgeons can encounter late-onset complications even decades after the surgery. Here, we report a case of very late-onset stomal obstruction following Gomez gastroplasty which was successfully treated by revision surgery.
A 58-year-old man was referred to our institution with sudden-onset nausea and vomiting. He underwent weight loss surgery in the USA in 1979, but the details of the surgery were unclear. Esophagogastroduodenoscopy demonstrated a stoma at the greater curvature of the upper gastric body, and fluoroscopy showed retention of contrast medium in the fundus and poor outflow through the stoma. Abdominal computed tomography revealed a staple line partitioning the stomach. Considering these preoperative investigation findings and the period during which the surgery was performed, the patient was diagnosed with very late-onset stomal obstruction following Gomez gastroplasty. Supporting the preoperative diagnosis, the surgical findings revealed a staple line extending from the lesser towards the greater curvature of the upper gastric body and a channel reinforced by a running seromuscular suture on the greater curvature. Moreover, gastric torsion caused by the enlarged proximal gastric pouch was found. Re-gastroplasty involving wedge resection of the original channel was performed followed by construction of a new channel. Postoperative course was uneventful, and the patient no longer had symptoms of stomal obstruction after revision surgery.
Re-gastroplasty was safe and feasible for very late-onset stomal obstruction following Gomez gastroplasty. Accurate preoperative diagnosis based on the patient's interview and the investigation findings was important for surgical planning. A careful follow-up is required to prevent excessive weight regain after revision surgery.
戈麦斯胃成形术于20世纪70年代开发，是用于严重肥胖症的胃限制性手术之一，使用吻合器在上部胃体从小弯向大弯分割胃，留下一个小通道。由于效果不佳，该手术已不再实施，但外科医生甚至在手术后数十年仍可能遇到迟发性并发症。在此，我们报告一例戈麦斯胃成形术后非常迟发性吻合口梗阻病例，该病例通过翻修手术成功治疗。
一名58岁男性因突发恶心和呕吐被转诊至我院。他于1979年在美国接受了减肥手术，但手术细节不明。食管胃十二指肠镜检查显示在上部胃体大弯处有一个吻合口，透视显示造影剂在胃底潴留且通过吻合口流出不畅。腹部计算机断层扫描显示胃被吻合钉线分割。考虑到这些术前检查结果以及手术实施的时间，该患者被诊断为戈麦斯胃成形术后非常迟发性吻合口梗阻。手术结果支持术前诊断，发现吻合钉线从上胃体小弯延伸至大弯，大弯处有一条连续浆肌层缝合加固的通道。此外，还发现了由扩大的近端胃囊引起的胃扭转。实施了包括切除原通道楔形部分的再次胃成形术，随后构建了一个新通道。术后过程顺利，翻修手术后患者不再有吻合口梗阻症状。
再次胃成形术对于戈麦斯胃成形术后非常迟发性吻合口梗阻是安全可行的。基于患者访谈和检查结果进行准确的术前诊断对于手术规划很重要。需要仔细随访以防止翻修手术后体重过度反弹。
