Hakim Mumin, Fathi Mohammed, Abdulraziq Mohammed, Al Shehri Mohammed
Department of General Surgery, Saudi German Hospital, Khamis Mushait, Al-Aseer, Saudi Arabia.
Department of Plastic and Reconstructive Surgery, Jacobi Medical Center, Bronx, NY, USA.
Surg Endosc. 2022 Nov;36(11):8503-8508. doi: 10.1007/s00464-022-09294-8. Epub 2022 Apr 29.
The current study objectively identified the incidence of adhesions between the stomach and pancreas in laparoscopic sleeve gastrectomy (LSG) patients on liraglutide (cases group) and off (control group) liraglutide.
This observational prospective study was conducted in the Department of General Surgery at Saudi German Hospital, Al-Aseer, Saudi Arabia (SGH) after approval by the Institutional Review Board. 117 patients with prior use of liraglutide and 101 patients with no liraglutide use scheduled for LSG over 12 months were included. Inclusion criteria included patients undergoing LSG with or without prior use of liraglutide. Exclusion criteria included patients with prior abdominal surgeries, bariatric surgery revisions, prior upper GI scope showing gastritis, Gastroesophageal Reflux Disease (GERD) or any other pathology, and other known causes of other causes of pancreatitis. Using laparoscopy obtained imaging during LSG cases adhesions between the posterior stomach and pancreas were identified.
The mean age of the patients in the cases and control groups was 32.44 ± 9.90 years and 28.23 ± 8.48 years (p = 0.001). The mean BMI of patients in the cases and control groups was 43.56 ± 4.59 and 45.00 ± 4.78, respectively (p = 0.024). 85% of the patients were females, while 17.0% were males in the cases group. 53.5% of the patients were females, while 47.0% were males in the control group (p < 0.001). In the cases group, 48.7% of patients had stopped liraglutide for no obvious reason. Under the cases group, 77.8% of the patients had no adhesions, while 22.2% had adhesions. Under the controls group, no adhesions were seen (p < 0.001).
Our results for the first time demonstrate an incidence of adhesions in 22.2% of patients undergoing LSG on prior liraglutide intake (p < 0.001). This study brings to light the possibility of adhesions in patients with prior exposure to liraglutide undergoing LSG. Surgeons performing LSG in patients with prior exposure to liraglutide should be cognizant of this possibility, thereby requiring careful meticulous dissection.
本研究客观地确定了接受腹腔镜袖状胃切除术（LSG）的患者在使用利拉鲁肽（病例组）和未使用利拉鲁肽（对照组）时胃与胰腺之间粘连的发生率。
本观察性前瞻性研究在沙特阿拉伯阿西尔市沙特德国医院（SGH）普通外科进行，经机构审查委员会批准。纳入117例曾使用利拉鲁肽的患者和101例计划在12个月内接受LSG且未使用利拉鲁肽的患者。纳入标准包括接受LSG的患者，无论之前是否使用过利拉鲁肽。排除标准包括有腹部手术史、减重手术翻修史、既往上消化道内镜检查显示胃炎、胃食管反流病（GERD）或任何其他病理情况以及其他已知胰腺炎病因的患者。在LSG手术过程中，通过腹腔镜获取图像以识别胃后壁与胰腺之间的粘连情况。
病例组和对照组患者的平均年龄分别为32.44±9.90岁和28.23±8.48岁（p = 0.001）。病例组和对照组患者的平均体重指数分别为43.56±4.59和45.00±4.78（p = 0.024）。病例组中85%的患者为女性，17.0%为男性。对照组中53.5%的患者为女性，47.0%为男性（p < 0.001）。在病例组中，48.7%的患者无明显原因停用了利拉鲁肽。在病例组中，77.8%的患者无粘连，22.2%有粘连。在对照组中，未见粘连（p < 0.001）。
我们的结果首次表明，在之前服用利拉鲁肽的LSG患者中，粘连发生率为22.2%（p < 0.001）。本研究揭示了既往接触过利拉鲁肽的患者在接受LSG时发生粘连的可能性。对既往接触过利拉鲁肽的患者进行LSG手术的外科医生应认识到这种可能性，因此需要仔细、细致地进行解剖。
