Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, 'La Sapienza' University of Rome-Polo Pontino, Bariatric Centre of Excellence SICOB, Latina, Italy.
Department of Medico-Surgical Sciences and Biotechnologies, Division of General Surgery and Bariatric Center of Excellence SICOB, Referral Training Center of ISHAWS (Italian Chapter EHS), 'La Sapienza' University of Rome, Roma, Italy.
Langenbecks Arch Surg. 2024 Aug 13;409(1):249. doi: 10.1007/s00423-024-03424-7.
Leaks after sleeve gastrectomy remain a deadly complication significantly affecting outcomes and medical costs. The aim of the present review is to provide an updated decalogue on leak prevention.
Risk factors of leakage after LSG were examined based on an extensive review of literature (in period time 2016-2024) and summary of evidence was provided using Oxford levels of evidence scale.
Pathogenesis of leakage after LSG still remain related to ischemic and mechanical factors and, therefore, no new evidence has been reported. Conversely, some technical aspect of the procedure has changed: bougie size, antrum resection, staple line reinforcement, and intraoperative leak testing.
Bougie size 36 F is effective and safe achieving similar leakage rate compared to larger bougie sizes (EL:2) 2024 UPDATE; There is no significant difference in the leak rate between restrictive (< 6 cm) and conservative (6 cm) antrum resection (EL: 1) 2024 UPDATE; Surgical experience and case volume affect the leak rate more consistently than every kind of SLR (EL: 2) 2024 UPDATE; Intraoperative leak test after LSG represents a decision based on surgeon preference in absence of standardization (endoscopy, bubble test, methylene blue, indocyanine green.) and strong detection/prevention rate (EL: 3) 2024 UPDATE.
袖状胃切除术后的漏液仍然是一种致命的并发症，严重影响手术结果和医疗费用。本综述的目的在于提供一套最新的关于预防漏液的十项建议。
基于对文献（2016-2024 年期间）的广泛回顾，检查了 LSG 后漏液的危险因素，并使用牛津证据等级量表提供了证据总结。
LSG 后漏液的发病机制仍与缺血和机械因素有关，因此没有新的证据报道。相反，该手术的一些技术方面已经发生了变化：胃管大小、胃窦切除、吻合口加固和术中漏液检测。
36F 号胃管是有效且安全的，其漏液发生率与更大号胃管（EL:2）相似；限制型（<6cm）和保守型（6cm）胃窦切除的漏液发生率无显著差异（EL: 1）；手术经验和病例量比任何一种 SLR 更能一致地影响漏液率（EL: 2）；LSG 后的术中漏液检测是基于外科医生的偏好，目前尚未标准化（内镜、气泡试验、亚甲蓝、吲哚菁绿），检测/预防率较高（EL: 3）。
