Lawani Ismaïl, Costantino Federico, Souaibou Yacoubou Imorou, Morelli Umber, Dossou Francis Moïse, Keller Philippe
Department of Surgery and Surgical Specialties, Faculty of Health Sciences, University of Abomey-Calavi, Benin; Department of General Digestive and Thoracic Surgery, Hôpital Pasteur, Colmar, France.
Department of General Digestive and Thoracic Surgery, Hôpital Pasteur, Colmar, France.
Int J Surg Case Rep. 2022 May;94:107043. doi: 10.1016/j.ijscr.2022.107043. Epub 2022 Apr 6.
The occurrence of a left hepatic vein injury during laparoscopic removal of an adjustable gastric band is exceptional and should be known by any surgeon approaching the hiatal region. We report here the laparoscopic control of such a wound.
A 39-year-old morbidly obese woman (body mass index 47.7 kg/m) presented the failure in weight loss following a laparoscopic adjustable gastric banding. It was decided to perform a one-step laparoscopic Roux-en-Y gastric bypass. Laparoscopic exploration showed post-surgical tissular retraction and adhesions. After the lap-band™ removal the left hepatic vein was accidentally bluntly injured while freeing adhesions between left hepatic lobe and the stomach. After a direct hemorrhagic control, intraoperative diagnosis of left hepatic vein injury was confirmed. A laparoscopic repair was performed by two running sutures using absorbable monofilament 4/0. Then, a Roux-en-Y gastric bypass was performed without any other complications. Operative time was 119 min; intraoperative blood loss was estimated as 200 cm. No blood transfusion was necessary. The total hospital stay was 48 h. The excess weight lost after 10 years was 87,9%.
Adjustable gastric band can modify anatomic landmarks, leading to a wrong dissection path, with possibility of left hepatic vein injury.
The left hepatic vein injury can occur during revisional surgery for laparoscopic adjustable gastric banding failure. Its laparoscopic management can be done safely, in trained hands without increasing morbidity.
在腹腔镜下拆除可调节胃束带过程中发生左肝静脉损伤的情况极为罕见，任何接近裂孔区域的外科医生都应有所了解。我们在此报告对此类伤口的腹腔镜处理。
一名39岁的病态肥胖女性（体重指数47.7kg/m²）在腹腔镜可调节胃束带手术后体重减轻失败。决定进行一步式腹腔镜Roux-en-Y胃旁路手术。腹腔镜探查显示术后组织回缩和粘连。在拆除胃束带后，在松解左肝叶与胃之间的粘连时，左肝静脉意外受到钝性损伤。在直接控制出血后，术中确诊为左肝静脉损伤。使用4/0可吸收单丝缝线进行了两针连续缝合的腹腔镜修复术。然后进行了Roux-en-Y胃旁路手术，未出现任何其他并发症。手术时间为119分钟；术中估计失血量为200ml。无需输血。总住院时间为48小时。10年后多余体重减轻了87.9%。
可调节胃束带会改变解剖标志，导致解剖路径错误，有可能损伤左肝静脉。
左肝静脉损伤可发生在腹腔镜可调节胃束带手术失败后的翻修手术中。在经验丰富的医生手中，其腹腔镜处理可以安全进行，且不会增加发病率。
