Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients

被引:286
作者
Sakran, Nasser [1 ,2 ]
Goitein, David [1 ,3 ,4 ]
Raziel, Asnat [5 ]
Keidar, Andrei [6 ]
Beglaibter, Nahum [6 ]
Grinbaum, Ronit [6 ]
Matter, Ibrahim [2 ,7 ]
Alfici, Ricardo [1 ,2 ]
Mahajna, Ahmad [2 ,8 ]
Waksman, Igor [9 ]
Shimonov, Mordechai [1 ,4 ,10 ]
Assalia, Ahmad [2 ,8 ]
机构
[1] Hillel Yaffe Med Ctr, Dept Surg, IL-38100 Hadera, Israel
[2] Technion Israel Inst Technol, Ruth & Bruce Rappaport Fac Med, Haifa, Israel
[3] Chaim Sheba Med Ctr, IL-52621 Tel Hashomer, Israel
[4] Tel Aviv Univ, Sackler Sch Med, IL-69978 Tel Aviv, Israel
[5] Assuta Hosp, Assia Med Grp, Tel Aviv, Israel
[6] Hadassah Hebrew Univ, Med Ctr, Jerusalem, Israel
[7] Bnai Zion Med Ctr, Haifa, Israel
[8] Rambam Hlth Care Campus, Haifa, Israel
[9] Ziv Med Ctr, Safed, Israel
[10] Wolfson Med Ctr, Holon, Israel
来源
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES | 2013年 / 27卷 / 01期
关键词
Gastric leak; Laparoscopic sleeve gastrectomy; Morbid obesity; Morbidity; Mortality; HIGH-RISK PATIENTS; MORBID-OBESITY; BARIATRIC OPERATION; MANAGEMENT; DIAGNOSIS; FISTULAS; SURGERY; BYPASS;
D O I
10.1007/s00464-012-2426-x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Laparoscopic sleeve gastrectomy (LSG) remains under scrutiny as a stand-alone bariatric procedure. The most feared complication after LSG is staple line leak. Eight bariatric centers in Israel participated in this study. A retrospective analysis was performed by querying all the LSG cases performed between June 2006 and June 2010. The data collected included patient demographics, anthropometrics, and operative and perioperative parameters. Among the 2,834 patients who underwent LSG, 44 (1.5 %) with gastric leaks were identified. Of these 44 patients, 30 (68 %) were women. The patients had a mean age of 41.5 years and a body mass index (BMI) of 45.4 kg/m(2). Intraoperative leak tests and routine postoperative swallow studies were performed with 33 patients, and all but one patient (3 %) failed to detect the leaks. Leaks were diagnosed at a median of 7 days postoperatively: early (0-2 days) in nine cases (20 %), intermediately (3-14 days) in 32 cases (73 %), and late (> 14 days) in three cases (7 %). For 38 patients (86 %), there was clinical suspicion, later confirmed by imaging or operative findings. Computed tomography, swallow studies, and methylene blue tests were performed for 37, 21, and 15 patients, respectively, and the results were positive, respectively, for 31 (84 %), 11 (50 %), and 9 (60 %) of these patients. Reoperation was performed for 27 of the patients (61 %). Other treatment methods included percutaneous drainage (n = 28, 63.6 %), endoscopic placement of stents (n = 11, 25 %), clips (n = 1, 2.3 %), and fibrin glue (n = 1, 2.3 %). In 33 of the patients (75 %), the leak site was found in the upper sleeve near the gastroesophageal junction. The median time to leak closure was 40 days (range, 2-270 days), and the overall leak-related mortality rate was 0.14 % (4/2,834). Gastric leak is the most common cause of major morbidity and mortality after LSG. Routine tests to rule out leaks seem to be superfluous. Rather, selective utilization is recommended. Management options vary, depending mainly on patient disposition. An accepted algorithm for the diagnosis and treatment of gastric leak has yet to be proposed.
引用
收藏
页码:240 / 245
页数:6
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