腹腔镜胃袖状切除术的技术细节

<正>腹腔镜胃袖状切除(laparoscopic sleeve gastrectomy,LSG)是目前常用减重手术技术。由于其相对胃旁路术简单、安全,术后营养问题较少,且其减重与代谢改善效果不亚于胃旁路术,近年得以广泛应用,在世界范围内约50%减重手术方式为腹腔镜胃袖状切除术[1-2]。为了规范的开展此种手术,获得理想减重效果,减少并发症发生机会,本文结合     

腹腔镜胃袖状切除术后胃漏1例报告

<正>近年,腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)因操作相对简单,可治疗肥胖合并疾病且减重效果明显,逐步得到广泛接受并成为独立的减重术式。然而随着LSG的广泛开展,其手术相关并发症的报道日趋增多,如术后胃漏、胃狭窄、胃食管反流、出血等。其中,胃漏是LSG术后最主要、最严重的并发症,因此对LSG术后胃漏的诊断、治疗、预防的相关研究及总结具有重要意义。本文现就我们近期收治的1例LSG术后胃漏患者的诊治过程做一总结,并结合文献对其发生因     

胃袖状切除复胖后再次胃袖状切除术

目的:探讨腹腔镜胃袖状切除术后再次胃袖状切除术的疗效及安全性。方法:回顾分析2016年6月至2018年1月因首次腹腔镜胃袖状切除术后复胖而再次行胃袖状切除术(ReSG)附加小肠转流术7例患者的临床资料,观察手术时间、住院时间、身体质量指数(BMI)变化情况及围手术期并发症。术前7例患者均行上消化道造影,显示胃底残留或残胃扩张。结果:7例手术均顺利完成,无术中并发症发生。中位手术时间125(110,150)min;中位住院时间8(7,9)d;ReSG术前BMI平均(27.6±2.1)kg/m~2,ReSG术后12个月BMI降为(22.3±2.1)kg/m~2。术后1例患者出现机械性肠梗阻,无其他术后并发症发生。结论:再次胃袖状切除术对于因胃底残留或残胃扩张而复胖的胃袖状切除术后患者是安全、有效的修正术式。     

对腹腔镜胃袖状切除术的再思考

正随着经济社会的发展和饮食结构的改变,中国的肥胖人数不断增加,男性和女性肥胖者由1975年的第12位和10位均上升到世界第1位~([1])。代谢外科手术是治疗肥胖和2型糖尿病唯一长期疗效确切的方法。术式方面,自1998年,Marceau等~([2])首次报道胃袖状切除术(sleeve gastrectomy,SG)后,经代谢外科医师的反复实践,SG被证明是一种疗效确     

腹腔镜胃袖状切除术后胃漏治疗3例分析

正胃漏是腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)后严重并发症之一,可引起腹腔感染,并导致脓毒血症和多器官功能衰竭。笔者医院开展LSG共160例,其中发生胃漏3例。现报告如下。1资料与方法1.1一般资料回顾性分析2012年1月至2015年5月同济大学附属东方医院糖尿病与减重外科收治的行LSG后发生胃漏的3例病人的临床资料,均为择期行LSG,术中使用     

腹腔镜胃袖状切除术治疗肥胖症

<正>外科减重是目前治疗病态性肥胖症最有效的途径。腹腔镜胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGBP)和腹腔镜可调节胃束带术(laparoscopic adjustable gastric banding,LAGB)是目前最常做的     

腹腔镜胃袖状切除术日间手术中国专家共识（2021版）

随着生活水平的改善和物质条件的极大丰富,肥胖症及其所合并的代谢性疾病越来越成为威胁人类健康的重要因素。根据《中国居民营养与慢性病状况报告(2020年)》,我国18岁及以上居民超重率和肥胖率已分别达到34.3%和16.4%,我国的肥胖人口总数高居世界第一位。     

单孔腹腔镜胃袖状切除术疗效的初步研究

目的 初步研究单孔腹腔镜胃袖状切除术(single-incision laparoscopic sleeve gastrectomy, SILSG)在轻中度肥胖病人的治疗结果。方法 回顾性收集上海交通大学医学院附属第九人民医院2019年8月至2021年2月行腹腔镜胃袖状切除术的266例病人临床资料,纳入接受SILSG的轻中度肥胖病人20例(SILSG组)和接受传统三孔腹腔镜胃袖状切除术(three-port laparoscopic sleeve gastrectomy, TPLSG)的轻中度肥胖病人47例(TPLSG组)。对比两组病人术后住院时间、手术时间、术中出血量、手术相关并发症发生情况,以评估手术安全性;对比两组病人术后12个月的总体重减轻百分比、体质量指数、颈围、胸围、腰围和臀围的改变以及肥胖相关代谢疾病的改善情况,评估减重疗效;对比两种术式的术后疼痛评分和美观满意度。结果 SILSG组的术后疼痛数字评分(NRS)优于TPLSG组[(1.5±0.3)分比(2.1±0.6)分,P<0.05],其美观满意比例也优于TPLSG组[90.0%比63.8%,P<0.05]。...     

Routine upper gastrointestinal swallow studies after laparoscopic sleeve gastrectomy are unnecessary

Background

Laparoscopic sleeve gastrectomy has gained popularity among bariatric surgeons. The purpose of this study was to evaluate the usefulness of early upper gastrointestinal (UGI) contrast studies in the detection of postoperative complications.

Methods

Radiographic reports were reviewed from April 2006 to January 2013. During that time, 161 patients underwent laparoscopic sleeve gastrectomy. All patients were submitted to UGI examination on postoperative day (POD) 1.

Results

Among the 161 patients who underwent UGI, no contrast leaks were found on POD 1. Three patients (1.9%) developed stapler line leaks near the gastroesophageal junction, which were diagnosed on PODs 3, 4, and 10. Gastroesophageal reflux in 5 patients (3.1%) and delayed gastroesophageal transit in 10 patients (6.2%) were detected.

Conclusions

The results of this study show that UGI series on POD 1 cannot assess the integrity of the gastric remnant. Early UGI series are not required as routine procedures in all operated patients. Computed tomographic swallow studies should be performed in patients who postoperatively develop clinical signs and symptoms of complications such as tachycardia, pain, or fever.     

Five-year results of laparoscopic sleeve gastrectomy

BackgroundLaparoscopic sleeve gastrectomy (LSG) is gaining popularity, but studies reporting long-term results are still rare. The objective of this study was to present the 5-year outcome concerning weight loss, modification of co-morbidities, and late complications.MethodsThis is a retrospective analysis of a prospective cohort with a minimal follow-up of 5 years. A total of 68 patients underwent LSG either as primary bariatric procedure (n = 41) or as redo operation after failed laparoscopic gastric banding (n = 27) between August 2004 and December 2007. At the time of LSG, the mean body mass index (BMI) was 43.0±8.0 kg/m², the mean age 43.1±10.1 years, and 78% were female. The follow-up rate was 100% at 1 year postoperatively, 97% after 2 years, and 91% after 5 years; the mean follow-up time was 5.9±0.8 years.ResultsThe average excessive BMI loss was 61.5%±23.4% after 1 year, 61.1%±23.4% after 2 years, and 57.4%±24.7% after 5 years. Co-morbidities improved considerably; a remission of type 2 diabetes could be reached at 85%. The following complications were observed: 1 leak (1.5%), 2 incisional hernias (2.9%), and new-onset gastroesophageal reflux in 11 patients (16.2%). Reoperation due to insufficient weight loss was necessary in 8 patients (11.8%).ConclusionsLSG was effective 5.9 years postoperatively with an excessive BMI loss of almost 60% and a considerable improvement or even remission of co-morbidities.     

Complications after laparoscopic sleeve gastrectomy

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) has recently become a feasible option in the management of morbid obesity. The objective of this study was to examine the morbidity and mortality arising from LSG as a primary procedure for weight loss. METHODS: We retrospectively reviewed the data of 164 patients who underwent LSG from 2004 to 2007. Patients underwent LSG as a primary procedure or as revisional bariatric surgery. The short-term morbidity and mortality were examined. RESULTS: One-stage LSG was performed in 148 patients. The major complication rate was 2.9% (4 of 149), including 1 leak (0.7%) and 1 case of hemorrhage (0.7%)-each requiring reoperation-1 case of postoperative abscess (0.7%), and 1 case of sleeve stricture that required endoscopic dilation (0.7%). One late complication of choledocholithiasis and bile duct stricture required a Whipple procedure. LSG was used as revisional surgery in 16 patients (9%); of these, 13 underwent LSG after complications related to laparoscopic adjustable gastric banding, 1 underwent LSG after aborted laparoscopic Roux-en-Y gastric bypass, and 2 underwent LSG after failed jejunoileal bypass. One of these patients developed a leak and an abscess (7.1%) requiring reoperation. One case was aborted, and 2 cases were converted to an open procedure secondary to dense adhesions. No patient died in either group. All but 3 cases were completed laparoscopically (98%). CONCLUSION: LSG is a relatively safe surgical option for weight loss as a primary procedure and as a primary step before a secondary nonbariatric procedure in high-risk patients.     

Gastroesophageal reflux disease complicating laparoscopic sleeve gastrectomy: current knowledge and surgical therapies

BackgroundLaparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric procedure worldwide. However, the incidence of gastroesophageal reflux disease (GERD) after LSG is high.ObjectivesThe aim of this systematic review was to identify the optimal surgical strategy for treating GERD after LSG.SettingWest China Hospital, Sichuan University, Chengdu, China.MethodsA systematic literature search was performed to identify studies on surgical treatments for GERD after LSG. The effectiveness and safety profile of surgical management on GERD after LSG were analyzed.ResultsA total of 40 articles enrolling 2049 patients were included in this review. Surgical strategies to prevent GERD after LSG were mainly of 2 types: concomitant LSG + antireflux procedures (hiatal hernia repair or fundoplication) and secondary procedures (conversion to Roux-en-Y gastric bypass [RYGB] or repeat sleeve gastrectomy). The short-term remission or improvement rate of GERD was 34.6%–100% after concomitant LSG + antireflux procedures. The postoperative complication rate was the same (3.0%) for both LSG + antireflux procedures and LSG alone. The remission or improvement rate of GERD was 57.1%–100% after conversion to RYGB and 100% after repeat sleeve gastrectomy.ConclusionsThe effectiveness and safety profile of concomitant LSG + antireflux procedures is uncertain. However, secondary operations after LSG, such as conversion to RYGB, appear to provide good results. The data overall are heterogeneous, with imprecise methods of documenting and defining GERD complicating LSG. More cohort studies or RCT studies of high quality with long-term follow-up are needed in the future.     

Laparoscopic sleeve gastrectomy in management of weight regain after failed laparoscopic plication

INTRODUCTIONWeight regain after bariatric surgery remains a challenging problem with regard to its surgical management.PRESENTATION OF CASEA 30 year-old-female patient with weight regain after failed laparoscopic gastric plication and previous gastric banding was evaluated in a tertiary-care university setting. Her last body mass index was calculated as 40.4 kg/m². Preoperative ultrasonography revealed cholelithiasis. Laparoscopic sleeve gastrectomy with cholecystectomy was planned as a redo surgery. A floopy and plicated stomach with increased wall thickness of the greater curvature was seen. After adhesiolysis between the plicated part of stomach and the surrounding omental tissues, concomitant laparoscopic sleeve gastrectomy and cholecystectomy were performed. She was discharged on the 4th post-operative day without any complaint. At the postoperative 3rd month, her body mass index was recorded as 24 kg/m².DISCUSSIONRedo surgery of morbid obesity after failed bariatric surgery is a technically demanding issue. Type of the surgical treatment should be decided by the attending surgeon based on the morphology of the remnant stomach caused by previous operations.CONCLUSIONAs a redo surgery after failed laparoscopic gastric plication and gastric banding procedures, laparoscopic sleeve gastrectomy may be regarded as a safe and feasible approach in experienced hands.     

Banded versus nonbanded laparoscopic sleeve gastrectomy: 5-year outcomes

Background/ObjectivesLaparoscopic sleeve gastrectomy (SG) is the most commonly performed bariatric/metabolic operation. However, inadequate long-term weight loss remains a problem in some cases, possibly from gastric-sleeve dilation. Adding a reinforcing ring around the proximal gastric sleeve has been proposed, but relevant data are scant. We performed the largest, longest-term study yet of banded SG (BSG) compared to nonbanded SG.SettingUniversity hospital.MethodsIn 2012, 68 patients at our institution underwent BSG, and 152 underwent SG. Data were prospectively collected into a standardized database from both cohorts during in-person visits at 0, .5, 1, 2, 3, 4, and 5 postoperative years, enabling this retrospective matched cohort study.ResultsThe groups were extremely well-matched at baseline for all relevant characteristics. Operative time was longer and blood loss greater with BSG, but these differences were clinically inconsequential. The only major perioperative complications were 1 hemorrhage in each group. Follow-up at 5 years was 81% for BSG and 67% for SG. Weight loss was equivalent between groups at 6 and 12 months. Thereafter, weight loss was substantially greater following BSG compared to SG at 2, 3, 4, and 5 years, with the magnitude of difference increasing at each successive year. At 5 years, total body mass index decrease was 33.0 ± 12.0% for BSG versus 21.7 ± 18.2% for SG (P = .0001). No major late complications occurred in either group. At 5 years, BSG patients reported minimal food intolerances, rare postprandial vomiting, and almost no heartburn.ConclusionsBSG is safe and produces substantially more weight loss than nonbanded SG at 2 through 5 postoperative years, with minimal side effects.     

腹腔镜袖状胃切除术在治疗单纯性肥胖症中的应用

肥胖目已成为当今世界日益普遍的健康问题,随着人们对于肥胖症的重视和科技的发展,减肥方式也在逐渐演变.近年来,袖状胃切除术的广泛应用使其已经成为全世界使用量排名第2位的减重手术方式.本文就有关袖状胃切除术治疗肥胖症的适应证与禁忌证、手术方式、手术效果、并发症等方面作一综述.     

Laparoscopic sleeve gastrectomy: Imaging of normal anatomic features and postoperative gastrointestinal complications

Morbid obesity is a public health problem in the United States and Europe and its prevalence is on the increase. Despite certain progress the efficacy of medical treatment remains limited. Bariatric surgery has consequently become an effective alternative for patients with morbid obesity. The bariatric operations most frequently performed are laparoscopic adjustable gastric banding (LAGB) and Roux-en-Y gastric bypass (LGB), but laparoscopic sleeve gastrectomy (LSG) is increasingly popular with both bariatric surgeons and patients due to its simplicity, rapidity and decreased morbidity. The purpose of this pictorial essay is to familiarize radiologists with the normal postoperative anatomic features and the imaging findings of postoperative gastrointestinal complications of laparoscopic sleeve gastrectomy because little literature exists on this subject.     

Outpatient laparoscopic sleeve gastrectomy in a free-standing ambulatory surgery center: First 250 cases

BackgroundA growing body of evidence supports the laparoscopic sleeve gastrectomy (LSG) as a safe and effective procedure for sustained weight loss and amelioration of weight-related co-morbidities. Procedures performed in ambulatory surgery centers (ASC) can provide several advantages over hospital-based surgery. We present our results of 250 consecutive patients undergoing LSG in an ASC. The objective of this study was to assess the safety and efficacy of outpatient LSG in a freestanding ASC.MethodsData was collected prospectively from 250 consecutive patients who underwent LSG at a freestanding ASC. Patients were excluded from the ASC if they weighed>450 pounds, if anticipated operative time was>2 hours, if the patient had impaired mobility limiting early ambulation, or if there were medical problems requiring postoperative monitoring beyond 23 hours. Revisions were not included in this study.ResultsMean age was 47 years (range, 23–74 yr). Mean preoperative body mass index (BMI) was 43 kg/m² (29–71 kg/m²). Mean operative time was 60 minutes (31–161 min). Mean recovery room time was 131 minutes (30–385 min). Mean percent excess weight loss (%EWL) was 60% at 1 year and 63% at 2 years. Nine patients (3.6%) were readmitted within 30 days. Two patients (.8%) were transferred from the ASC to a hospital. There was 1 staple line leak (.4%). There were no open conversions and no deaths.ConclusionsLSG can be performed safely in a freestanding ASC in select patients with outcomes comparable to the inpatient standard. Additional studies are needed to formulate selection criteria and guidelines to maximize patient safety and outcomes.