Department of Surgery, Icahn School of Medicine at Mt Sinai, New York, NY.
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
JSLS. 2022 Jul-Sep;26(3). doi: 10.4293/JSLS.2022.00029.
Laparoscopic sleeve gastrectomy has become one of the most popular bariatric surgeries in the United States with a low rate of morbidity and effective weight loss. However, staple line leak remains a feared complication requiring a lengthy and difficult treatment course until resolution. This study outlines the various treatment methods used within a high-volume bariatric practice for successful leak resolution without necessitating a conversion procedure.
A retrospective review was conducted on all patients with staple line leak after laparoscopic sleeve gastrectomy in a three-surgeon bariatric practice from January 1, 2010 to December 31, 2019.
A total of 10 staple line leaks were identified with a leak rate of 0.9%. Patients presented on average 29.3 days postoperatively and were all diagnosed on computed tomography. Three patients were initially managed operatively with washout and drainage procedure. Six patients were managed endoscopically initially with either stent or over-the-scope clip placement. Most patients required multiple interventions with an average of 2.4 interventions per patient. Average time to leak resolution was 48.2 days (15-95 days).
Management of staple line leaks after laparoscopic sleeve gastrectomy requires a multimodal approach usually requiring multiple interventions before leak resolution. We demonstrate effective utilization of varying interventions that lead to effective leak resolution and avoid conversion operations.
腹腔镜袖状胃切除术已成为美国最受欢迎的减肥手术之一，其发病率低，减肥效果显著。然而，吻合口漏仍然是一种令人恐惧的并发症，需要长时间且困难的治疗过程才能解决。本研究概述了在高容量减重手术实践中，用于成功解决吻合口漏而无需进行转换手术的各种治疗方法。
对 2010 年 1 月 1 日至 2019 年 12 月 31 日期间，由三位外科医生进行的腹腔镜袖状胃切除术后吻合口漏的所有患者进行了回顾性研究。
共发现 10 例吻合口漏，漏诊率为 0.9%。患者平均在术后 29.3 天出现症状，所有患者均经计算机断层扫描（CT）确诊。有 3 例患者最初采用手术冲洗和引流治疗。有 6 例患者最初采用内镜下支架或内镜下夹闭术治疗。大多数患者需要多次干预，平均每位患者需要 2.4 次干预。吻合口漏的平均愈合时间为 48.2 天（15-95 天）。
腹腔镜袖状胃切除术后吻合口漏的处理需要采用多模式方法，通常需要多次干预才能解决吻合口漏。我们证明了不同干预措施的有效利用，这些措施可有效解决吻合口漏并避免转换手术。
