Cucchi S G, Pories W J, MacDonald K G, Morgan E J
Department of Surgery, East Carolina University School of Medicine, Greenville, North Carolina, USA.
Ann Surg. 1995 Apr;221(4):387-91. doi: 10.1097/00000658-199504000-00009.
This report warns that gastrogastric fistulas may follow the division of the stomach in bariatric surgery.
Although surgery is the most effective therapy for morbid obesity, the procedures are still undergoing evolution. One of the key elements in bariatric surgery is the partition of the stomach to develop a much smaller reservoir. The partition has been done with single layers of staples with almost universal failure and with double layers of staples with a failure rate of 11.8% when observed for a 12-year follow-up.
This report details the experience with a series of 100 consecutive patients in whom the partition was created by dividing the stomach.
The course of six patients was complicated by gastrogastric fistulas. One of the patients had the gastric bypass as the initial bariatric operation; in the other five, the gastric bypasses were carried out to revise failed staple lines. Although one of the patients required drainage for a subphrenic abscess, two had only self-limited signs of infection. In the remaining three patients, there was no evidence of any complication.
Gastrogastric fistulas followed division of the stomach in 6% of our gastric bypass operations. Methods for avoiding this complication include oversewing staple lines, using strong bites of tissue during the anastomosis, avoiding obstruction of the Roux-en-Y jejunal segment, and testing of the integrity of the anastomosis with methylene blue dyes. The ideal method for partition of the stomach remains to be developed.
本报告警示，减重手术中胃的分割可能会导致胃胃瘘。
尽管手术是治疗病态肥胖最有效的方法，但相关手术仍在不断发展。减重手术的关键要素之一是对胃进行分割，以形成一个小得多的胃腔。胃的分割曾采用单层吻合钉，几乎普遍失败；采用双层吻合钉时，在12年的随访中失败率为11.8%。
本报告详细介绍了连续100例通过胃分割进行胃腔构建患者的经验。
6例患者出现胃胃瘘并发症。其中1例患者最初接受的减重手术是胃旁路手术；另外5例患者是在吻合钉线失败后进行胃旁路手术以进行修复。尽管1例患者因膈下脓肿需要引流，但另外2例仅有自限性感染体征。其余3例患者未发现任何并发症迹象。
在我们的胃旁路手术中，6%的病例在胃分割后出现胃胃瘘。避免这种并发症的方法包括缝合吻合钉线、在吻合时牢固咬取组织、避免Roux-en-Y空肠段梗阻以及用亚甲蓝染料检测吻合口的完整性。理想的胃分割方法仍有待开发。
