Emirates Specialty Hospital, Dubai, UAE.
ELSAN, Clinique Bouchard, Marseille, France.
Obes Surg. 2023 Oct;33(10):3317-3322. doi: 10.1007/s11695-023-06780-3. Epub 2023 Aug 23.
Laparoscopic BariClip gastroplasty (LBCG) is a new reversible gastric sleeve-like procedure without gastrectomy proposed to minimize the risk of severe complications. Still one of the possible complications described with LBCG is slippage. The purpose of the current manuscript is to analyze different cases of slippage and propose a classification of this complication.
A number of 381 patients who underwent LBCG in 8 different centers were analyzed concerning the risk of slippage. All cases with documented slippage were carefully reviewed in terms of patients' symptomatology (presence of satiety, vomiting), history of weight loss, radiological data, and management of their slippage. A new classification was proposed depending on the anatomy, the symptomatology, and the time of occurrence.
We have identified a total of 17 cases (4.46%) of slippage following LBCG. In 11 patients, the slippage was symptomatic with repetitive vomiting and nausea, and in the remaining 6 patients, the slippage was identified by radiological studies for insufficient weight loss, weight regain, or routine radiological follow-up. Depending on the interval time, the slippage was classified as either immediate (in first 7 days) in 6 cases, early (in less than 90 days) in 4 cases, and late (after 3 months) in 7 cases. Evaluation of the radiological studies in these cases identified the following: anterosuperior displacement (type A) in 9 cases, posteroinferior displacement (type B) in 6 cases (one case after 3 months), and lateral displacement (type C) in the remaining 2 cases. The management of the slippage consisted of BariClip removal in 7 cases, repositioning in 5 cases, and conservative treatment in the remaining 5 cases. All patients with conservative treatment were recorded at the beginning of the experience.
Slippage is a possible complication after LBCG. This classification of the different types of slippage can benefit the surgeon in the management and treatment of this complication of LBCG.
腹腔镜 BariClip 胃成形术（LBCG）是一种新的可逆胃袖套样手术，无需胃切除术，旨在最大限度地降低严重并发症的风险。尽管如此，LBCG 描述的一种可能的并发症仍然是滑脱。本手稿的目的是分析不同的滑脱病例，并提出这种并发症的分类。
对 8 个不同中心接受 LBCG 的 381 名患者进行分析，以评估滑脱的风险。对所有有记录的滑脱病例，从患者的症状（饱腹感、呕吐）、减肥史、影像学数据和滑脱的处理等方面进行了仔细回顾。根据解剖结构、症状和发生时间提出了一种新的分类。
我们共发现 17 例（4.46%）LBCG 后发生滑脱。在 11 例患者中，滑脱症状为反复呕吐和恶心，在其余 6 例患者中，滑脱是通过影像学研究发现的，原因是体重减轻不足、体重反弹或常规影像学随访。根据间隔时间，滑脱可分为早期（7 天内）6 例、早期（90 天内）4 例和晚期（3 个月后）7 例。对这些病例的影像学研究评估发现：9 例为前上移位（A型），6 例为后下移位（B 型）（其中 1 例发生在 3 个月后），2 例为侧方移位（C 型）。滑脱的处理包括 7 例 BariClip 取出、5 例复位和 5 例保守治疗。所有接受保守治疗的患者均在经验开始时记录在案。
滑脱是 LBCG 后的一种可能并发症。这种不同类型滑脱的分类可以使外科医生在处理和治疗 LBCG 的这种并发症时受益。
