DeAngelis Erik J, Lee Juliet, Habboosh Noor, Ichiuji Brynne A, Amdur Richard L, Lin Paul, Vaziri Khashayar, Jackson Hope T
Department of Surgery, George Washington University, Washington, DC.
Surg Laparosc Endosc Percutan Tech. 2023 Feb 1;33(1):55-61. doi: 10.1097/SLE.0000000000001144.
During laparoscopic sleeve gastrectomy (LSG), many surgeons use an intraoperative sizing device. However, the choice of intraoperative sizing device varies and the optimal choice or combination of sizing devices, such as a bougie or esophagogastroduodenoscopy (EGD), is not known. The purpose of this study was to determine if there is an association between the use of a sizing device or a combination of sizing devices on rates of dehydration, bleeding, and staple line leak following LSG.
Patients between the ages of 18 to 80 who underwent elective LSG were identified using the American College of Surgeons Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (ACS-MBSAQIP) database from 2015 to 2019. Postoperative outcomes, including rates of dehydration, bleeding, and staple line leak, were compared across 4 groups: those that utilized bougie and EGD (both), those that utilized only bougie (bougie only), those that utilized only EGD (EGD only), and those that did not utilize either sizing device (neither).
In all, 533,151 cases met the inclusion criteria. On univariate analysis, the bougie-only group experienced the highest rates of dehydration events. On multivariate analysis, the use of both sizing devices was associated with significantly lower odds of events related to dehydration versus bougie only (aOR 0.869, P =0.0002), and bougie only was associated with significantly higher odds of events related to dehydration versus EGD only (aOR 1.773, P =0.0006).The neither-sizing device group did not show any statistically significant differences in any of the comparisons.
Bougie use alone was associated with more dehydration-related complications, while EGD use demonstrated a protective effect. Not using a sizing device was associated with equivalent outcomes to all combinations of sizing devices. These findings highlight the need for the standardization of sizing devices during LSG and suggest that foregoing sizing devices may be a management option without early adverse sequelae.
在腹腔镜袖状胃切除术（LSG）过程中，许多外科医生使用术中尺寸测量装置。然而，术中尺寸测量装置的选择各不相同，且尺寸测量装置（如探条或食管胃十二指肠镜检查（EGD））的最佳选择或组合尚不清楚。本研究的目的是确定在LSG后，使用尺寸测量装置或尺寸测量装置组合与脱水、出血和吻合口漏发生率之间是否存在关联。
使用美国外科医师学会代谢与减重手术认证及质量改进项目（ACS-MBSAQIP）数据库，确定2015年至2019年间接受择期LSG的18至80岁患者。比较四组患者的术后结果，包括脱水、出血和吻合口漏发生率：使用探条和EGD的患者（两者都用）、仅使用探条的患者（仅用探条）、仅使用EGD的患者（仅用EGD）以及未使用任何尺寸测量装置的患者（两者都不用）。
共有533151例病例符合纳入标准。单因素分析显示，仅用探条组的脱水事件发生率最高。多因素分析显示，与仅用探条相比，同时使用两种尺寸测量装置与脱水相关事件的发生率显著降低相关（调整后比值比[aOR]为[具体数值]，P = 0.0002），且仅用探条与仅用EGD相比，脱水相关事件的发生率显著升高相关（aOR为[具体数值]，P = 0.0006）。在任何比较中，未使用尺寸测量装置组均未显示出任何统计学上的显著差异。
单独使用探条与更多脱水相关并发症相关，而使用EGD则显示出保护作用。不使用尺寸测量装置与所有尺寸测量装置组合的结果相当。这些发现凸显了LSG期间尺寸测量装置标准化的必要性，并表明不使用尺寸测量装置可能是一种无早期不良后果的管理选择。
