Nedelcu Marius, Manos Thierry, Noel Patrick, Danan Marc, Zulian Viola, Vilallonga Ramon, Nedelcu Anamaria, Carandina Sergio
ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Óbesite, 83000 Toulon, France.
ELSAN, Clinique Bouchard, 13006 Marseille, France.
J Clin Med. 2023 Feb 9;12(4):1376. doi: 10.3390/jcm12041376.
Despite the unanimous acknowledgement of the laparoscopic sleeve gastrectomy (LSG) worldwide, the leak remains its deficiency. For the last decade, the surgical treatment was practically considered mandatory for almost any collection following LSG. The aim of this study is to evaluate the need for surgical drainage for leak following LSG.
All consecutive patients having gone through LSG from January 2017 to December 2020 were enrolled in our study. Once the demographic data and the leak history were registered, we analyzed the outcome of the surgical or endoscopic drainage, the characteristics of the endoscopic treatment, and the evolution to complete healing.
A total of 1249 patients underwent LSG and the leak occurred in 11 cases (0.9%). There were 10 women with a mean age of 47.8 years (27-63). The surgical drainage was performed for three patients and the rest of the eight patients underwent primary endoscopic treatment. The endoscopic treatment was represented with pigtails for seven cases and septotomy with balloon dilation for four cases. In two out of these four cases, the septotomy was anticipated by the use of a nasocavitary drain for 2 weeks. The average number of endoscopic procedures was 3.2 (range 2-6). The leaks achieved complete healing after an average duration of 4.8 months (range 1-9 months). No mortality was recorded for a leak.
The treatment of the gastric leak must be tailored to each patient. Although there is still no consensus for the endoscopic drainage of leaks after LSG, the surgical approach can be avoided in up to 72%. The benefits of pigtails and nasocavitary drains followed by endoscopic septotomy are undeniable, and they should be included in the armamentarium of any bariatric center.
尽管腹腔镜袖状胃切除术（LSG）在全球范围内得到了一致认可，但其仍存在渗漏这一不足之处。在过去十年中，对于LSG术后几乎任何积液情况，手术治疗实际上都被视为必要手段。本研究的目的是评估LSG术后渗漏进行手术引流的必要性。
纳入2017年1月至2020年12月期间所有连续接受LSG手术的患者。记录人口统计学数据和渗漏病史后，我们分析了手术或内镜引流的结果、内镜治疗的特点以及完全愈合的进展情况。
共有1249例患者接受了LSG手术，其中11例（0.9%）发生了渗漏。有10名女性，平均年龄47.8岁（27 - 63岁）。3例患者接受了手术引流，其余8例患者接受了初次内镜治疗。内镜治疗中，7例采用猪尾导管，4例采用球囊扩张隔膜切开术。在这4例中的2例中，在使用鼻腔引流管2周后进行了隔膜切开术。内镜治疗的平均次数为3.2次（范围2 - 6次）。渗漏平均在4.8个月（范围1 - 9个月）后完全愈合。未记录到因渗漏导致的死亡病例。
胃渗漏的治疗必须因人而异。尽管对于LSG术后渗漏的内镜引流仍未达成共识，但高达72%的患者可以避免手术治疗。猪尾导管和鼻腔引流管随后进行内镜隔膜切开术的益处是不可否认的，它们应被纳入任何减肥中心的治疗手段中。
