Hirosuna Kensuke, Kashima Hajime, Shoji Ryohei, Matsumi Yuki, Kakiuchi Yoshihiko, Kikuchi Satoru, Kuroda Shinji, Teraishi Fuminori, Kagawa Shunsuke, Fujiwara Toshiyoshi
Center for Graduate Medical Education, Okayama University Hospital, Okayama, Okayama, Japan.
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.25-0141. Epub 2025 Jun 10.
Gastric diverticulum is a rare condition, often asymptomatic and incidentally detected. Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric procedure, but a gastric diverticulum complicates surgical planning. In this case, careful preoperative assessment allowed safe execution of LSG despite the diverticulum's proximity to the esophagogastric junction.
A 45-year-old woman (BMI: 46.8 kg/m) with hypertension, dyslipidemia, and glucose intolerance was referred for bariatric surgery after unsuccessful weight loss with conservative management. Preoperative endoscopy revealed an 18 × 14 mm gastric diverticulum on the posterior wall of the gastric fundus, 40 mm from the esophagogastric junction. LSG was performed using a surgical stapler, ensuring complete diverticulum resection while preserving gastric tube integrity. The surgery was uneventful, with minimal blood loss and a duration of 2 hours and 52 minutes. The patient had an uneventful postoperative course and was discharged on day 9. Her BMI decreased to 39.3 kg/m at the 1-year follow-up, with improved metabolic parameters.
This case highlights the importance of thorough preoperative evaluation when performing LSG in patients with gastric diverticulum. Accurate endoscopic measurement of the diverticulum's location aids in determining the optimal resection line, ensuring surgical safety and efficacy. Surgeons should remain vigilant when encountering such anatomical variations to optimize outcomes in bariatric surgery.
胃憩室是一种罕见病症，通常无症状，多为偶然发现。腹腔镜袖状胃切除术（LSG）是一种广泛开展的减肥手术，但胃憩室会使手术规划变得复杂。在此病例中，尽管憩室靠近食管胃交界处，但经过仔细的术前评估，仍安全实施了LSG。
一名45岁女性（BMI：46.8kg/m²），患有高血压、血脂异常和糖耐量异常，在保守治疗减肥失败后转诊接受减肥手术。术前内镜检查发现胃底后壁有一个18×14mm的胃憩室，距食管胃交界处40mm。使用手术吻合器进行了LSG，在保留胃管完整性的同时确保完全切除憩室。手术过程顺利，出血极少，持续时间为2小时52分钟。患者术后恢复顺利，于第9天出院。在1年随访时，她的BMI降至39.3kg/m²，代谢参数有所改善。
该病例强调了在胃憩室患者中进行LSG时全面术前评估的重要性。准确的内镜测量憩室位置有助于确定最佳切除线，确保手术安全和疗效。在减肥手术中遇到此类解剖变异时，外科医生应保持警惕，以优化手术效果。
