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1.
Background
This is a prospective pilot study done to evaluate the feasibility and to assess the outcomes and complication rates of the single-incision sleeve gastrectomy versus the conventional five-port laparoscopic sleeve gastrectomy. 相似文献2.
Short-Term Outcomes of Sleeve Gastrectomy for Morbid Obesity: Does Staple Line Reinforcement Matter?
Background
Stand-alone laparoscopic sleeve gastrectomy (LSG) has been found to be effective in producing weight loss but few large, one-center LSG series have been reported. Gastric leakage from the staple line is a life-threatening complication of LSG, but there is controversy about whether buttressing the staple line with a reinforcement material will reduce leaks. We describe a single-center, 518-patient series of LSG procedures in which a synthetic buttressing material (GORE® SEAMGUARD® Bioabsorbable Staple Line Reinforcement) was used in the most recently treated patients.Methods
We retrospectively reviewed the medical records of all patients who underwent LSG in our unit between September 2007 and December 2011. Patients treated before August 2009 did not receive the staple line reinforcement material (n?=?186), whereas all patients treated afterward did (n?=?332).Results
The percentages of excess weight loss in the 518 patients (mean age, 41 years; 82 % female; mean preoperative body mass index, 44 kg/m2) were 67 % (79 % follow-up rate) at 6 months postoperatively, 81 % (64 %) at 1 year, and 84 % (30 %) at 2 years. Type 2 diabetes resolved in 71 % of patients (91/128). Patients given reinforcement material had baseline characteristics similar to those in the no-reinforcement-material group, but had no postoperative staple line leaks or bleeding. The no-reinforcement group had three leaks (p?=?0.045) and one case of bleeding.Conclusions
LSG resulted in substantial short-term weight loss. Use of the bioabsorbable staple line reinforcement material may decrease leaks after LSG. 相似文献3.
Background
This study aims to identify whether reinforcing the staple line during laparoscopic sleeve gastrectomy (LSG) has advantages.Methods
We searched MEDLINE (PubMed; till August 2011), EMBASE (till August 2011), and the Cochrane Central Register of Controlled Trials (Central) in the Cochrane Library (till August 2011) using common keywords related to sleeve gastrectomy and reinforcement. The keywords were as follows: ??sleeve gastrectomy?? and ??reinforcement,?? or ??reinforcing,?? or ??reinforce,?? or ??leak,?? or ??leakage,?? or ??staple,?? or ??stapling,?? or ??oversew,?? or ??oversewing,?? or ??oversewed.?? The language of publication was limited to English only.Results
Of the 358 articles meeting our initial criteria, eight full texts (two randomized control trial [RCT] and six cohort studies), involving 1,345 participants (828 patient cases and 517 controls) were included in the final analysis. Comparing the reinforcement of the staple line to no reinforcement of the staple line, the odds ratio (OR) for overall complications was 0.521 (95?% confidence intervals [CI], 0.349?C0.777). In addition, the OR for staple line leak was 0.425 (95?% CI, 0.226?C0.799) and for staple line hemorrhage was 0.559 (95?% CI, 0.247?C1.266).Conclusion
The current study showed that reinforcing the staple line during LSG has the following advantages: decreased incidence of postoperative leak and overall complications. More prospective studies with better evidence are needed. 相似文献4.
Yehoshua RT Eidelman LA Stein M Fichman S Mazor A Chen J Bernstine H Singer P Dickman R Beglaibter N Shikora SA Rosenthal RJ Rubin M 《Obesity surgery》2008,18(9):1083-1088
BACKGROUND: Aiming to clarify the mechanism of weight loss after the restrictive bariatric procedure of sleeve gastrectomy (LSG), the volumes and pressures of the stomach, of the removed part, and of the remaining sleeve were measured in 20 morbidly obese patients. METHODS: The technique used consisted of occlusion of the pylorus with a laparoscopic clamp and of the gastroesophageal junction with a special orogastric tube connected to a manometer. Instillation of methylene-blue-colored saline via the tube was continued until the intraluminal pressure increased sharply, or the inflated stomach reached 2,000 cc. After recording of measurements, LSG was performed. RESULTS: Mean volume of the entire stomach was 1,553 cc (600-2,000 cc) and that of the sleeve 129 cc (90-220 cc), i.e., 10% (4-17%) and that of the removed stomach was 795 cc (400-1,500 cc). The mean basal intragastric pressure of the whole stomach after insufflations of the abdominal cavity with CO(2) to 15 mmHg was 19 mmHg (11-26 mmHg); after occlusion and filling with saline it was 34 mmHg (21-45 mmHg). In the sleeved stomach, mean basal pressure was similar 18 mmHg (6-28 mmHg); when filled with saline, pressure rose to 43 mmHg (32-58 mmHg). The removed stomach had a mean pressure of 26 mmHg (12-47 mmHg). There were no postoperative complications and no mortality. CONCLUSIONS: The notably higher pressure in the sleeve, reflecting its markedly lesser distensibility compared to that of the whole stomach and of the removed fundus, indicates that this may be an important element in the mechanism of weight loss. 相似文献
5.
6.
Background Although the efficacy of laparoscopic sleeve gastrectomy (LSG) for morbidly obese patients with a BMI of < 50 kg/m2, the incidence of weight gain by change of eating behaviors, and gastric dilatation following LSG have not been investigated
thus far, LSG is becoming more common as a single-stage operation for the treatment morbid obesity.
Methods This is a prospective study of the initial 120 patients who underwent isolated LSG. Initially, the LSG was performed without
a calibration tube and resulted in high sleeve volumes (group 1: n = 25). In group 2 (n = 32), a calibration tube of 44 Fr
and in group 3 (n = 63) a calibration tube of 32 Fr were used. The study group consists of 101 patients with high BMI who
were scheduled for a two-step LBPD-DS, but rejected the second step after 1 year. Study endpoints include estimated sleeve
volume, volume of removed stomach, operative time, complication rates, length of hospital stay, changes in co-morbidity, percentage
of excess BMI loss (%EBL) and changes in BMI (kg/m2).
Results All 3 groups were comparable regarding age, gender, and co-morbidities. There was no hospital mortality, but there was one
case of late mortality (0.8%). 2 early leaks (1.7%) were seen. % excess BMI loss was significantly higher for patients who
underwent LSG with tube calibrations. LSG with large sleeve volume showed a slight weight gain during 5 years of observation.
A total of 16 patients (13.3%) underwent a second stage procedure within a period of 5 years (2 redo-sleeves, 7 LBPD-DS, 3
LRYGBP).
Conclusion Early weight loss results were not different between the groups, but after 2 years the more restrictive LSG (groups 2, 3)
results were significantly better than in patients without calibration. A removed gastric volume of < 500 cc seems to be a
predictor of failure in treatment or early weight regain. A statistically significant improved health status and quality of
life were registered for all groups. The general introduction of LSG as a one-stage restrictive procedure in the bariatric
field can be considered only if the procedure is standardized and long-term results are available. 相似文献
7.
Background
Isolated sleeve gastrectomy is being used with increasing frequency for the treatment of morbid obesity. This study was done to determine the potential benefit of placing a band of processed human dermis around the upper portion of a sleeve gastrectomy to prevent late dilatation and weight gain. 相似文献8.
Frank Benedix Diana D. Benedix Christian Knoll Rudolf Weiner Christiane Bruns Thomas Manger Christine Stroh Obesity Surgery Working Group Competence Network Obesity 《Obesity surgery》2014,24(10):1610-1616
Background
Laparoscopic sleeve gastrectomy (LSG) is currently being performed with increasing frequency worldwide. It offers an excellent weight loss and resolution of comorbidities in the short term with a very low incidence of complications. However, the ever present risk of a staple line leak is still a major concern.Methods
Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered in an online database and analyzed at the Institute of Quality Assurance in Surgical Medicine. For the current analysis, all patients that had undergone primary sleeve gastrectomy for morbid obesity within a 7-year period were considered.Results
Using the GBSR, data from 5.400 LSGs were considered for analysis. Staple line leak rate decreased during the study period from 6.5 to 1.4 %. Male gender, higher BMI, concomitant sleep apnea, conversion to laparotomy, longer operation time, use of both buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate. On multivariate analysis, operation time and year of procedure only had a significant impact on staple line leak rate.Conclusions
The results of the current study demonstrated that there are factors that increase the risk of a leakage which would enable surgeons to define risk groups, to more carefully select patients, and to offer a closer follow-up during the postoperative course with early recognition and adequate treatment. All future efforts should be focused on a further reduction of serious complications to make the LSG a widely accepted and safer procedure. 相似文献9.
10.
Melissas J Koukouraki S Askoxylakis J Stathaki M Daskalakis M Perisinakis K Karkavitsas N 《Obesity surgery》2007,17(1):57-62
Background Diet and surgically-induced weight loss have been shown to lead to alterations in motor and sensory function of the stomach.We
investigated the clinical outcome and gastric emptying of solid foods in morbidly obese (MO) patients following sleeve gastrectomy
(SG).
Methods We studied 23 MO patients [(7 males, 16 females), mean age 38.9 ± 11.0 years (range 20–64 years), mean weight 135.1 ± 19.0 kg
(range 97–167 kg), mean BMI 47.2 ± 4.8 kg/m2 (range 39.6–56.0 kg/m2)] who each underwent a sleeve gastrectomy (SG) for weight
reduction. At the monthly follow-up visits, variations in weight and BMI changes, postoperative meal size and frequency, and
presence of gastrointestinal symptoms were recorded. 11 patients underwent scintigraphic measurement of the gastric emptying
of a solid meal pre- and 6 months postoperatively.
Results A significant reduction in patients’ weight was evidenced at 6 and 12 months postoperatively [98.6 ± 11.8 kg and 87.0 ± 10.7 kg
respectively (P = 0.001)]. BMI decreased to 35.2 ± 4.3 kg/m2 at 6 months and to 31.1 ± 4.5 kg/m2 at 12 months, respectively (P = 0.001). Although meal size was drastically reduced, meal frequency increased postoperatively in 12 patients (52.2%). Only
5 patients (21.8%) reported occasional vomiting after meals following SG. The gastric emptying half-time (T1/2) accelerated
(47.6 ± 23.2 vs. 94.3 ± 15.4, P < 0.01) and the T-lag phase duration decreased (9.5 ± 2 min vs. 19.2 ± 2 min, P < 0.05) postoperatively. The percentage of the meal emptied from the stomach 90 min after consumption increased significantly
after SG (75.4 ± 14.9% vs. 49.2 ± 8.7%, P < 0.01).
Conclusions This study indicates that following SG, the stomach empties its contents rapidly into the small intestine and symptoms of
vomiting after eating (characteristic of restrictive procedures) are either absent or very mild. Therefore, the term ‘restrictive’
is possibly ill-advised for this new bariatric operation. It remains for other mechanisms of energy intake reduction, such
as intestinal distension and satiety signals through gut hormones to be investigated, to comprehensively explain precisely
how this ‘food limiting’ procedure results in weight loss. 相似文献
11.
Monica Sethi Karan Patel Jonathan Zagzag Manish Parikh John Saunders Aku Ude-Welcome Eduardo Somoza Bradley Schwack Marina Kurian George Fielding Christine Ren-Fielding 《Journal of gastrointestinal surgery》2016,20(2):244-252
Background
Thirty-day readmission post-bariatric surgery is used as a metric for surgical quality and patient care. We sought to examine factors driving 30-day readmissions after laparoscopic sleeve gastrectomy (LSG).Methods
We reviewed 1257 LSG performed between March 2012 and June 2014. Readmitted and nonreadmitted patients were compared in their demographics, medical histories, and index hospitalizations. Multivariable regression was used to identify risk factors for readmission.Results
Forty-five (3.6 %) patients required 30-day readmissions. Forty-seven percent were readmitted with malaise (emesis, dehydration, abdominal pain) and 42 % with technical complications (leak, bleed, mesenteric vein thrombosis). Factors independently associated with 30-day readmission include index admission length of stay (LOS) ≥3 days (OR 2.54, CI?=?[1.19, 5.40]), intraoperative drain placement (OR 3.11, CI?=?[1.58, 6.13]), postoperative complications (OR 8.21, CI?=?[2.33, 28.97]), and pain at discharge (OR?8.49, CI?=?[2.37, 30.44]). Patients requiring 30-day readmissions were 72 times more likely to have additional readmissions by 6 months (OR?72.4, CI?=?[15.8, 330.5]).Conclusions
The 30-day readmission rate after LSG is 3.6 %, with near equal contributions from malaise and technical complications. LOS, postoperative complications, drain placement, and pain score can aid in identifying patients at increased risk for 30-day readmissions. Patients should be educated on postoperative hydration and pain management, so readmissions can be limited to technical complications requiring acute inpatient management.12.
S. Carandina M. Tabbara M. Bossi A. Valenti C. Polliand L. Genser Christophe Barrat 《Journal of gastrointestinal surgery》2016,20(2):361-366
Background
Laparoscopic sleeve gastrectomy (LSG) is associated with serious complications, such as staple line (SL) leaks and bleeding. In order to prevent the occurrence of these complications, surgeons have advocated the need to strengthen the staple line. The aim of this randomized controlled study was to compare the efficacy of three different ways of strengthening of the SL in LSG in preventing surgical post-operative complications.Methods
Between April 2012 and December 2014, 600 patients (pts) scheduled for LSG were prospectively randomized into groups without SL reinforcement (group A) or with SL reinforcement including fibrin glue coverage (group B), or oversewn SL with imbricating absorbable (Monocryl?; group C) or barbed (V lock®) running suture (group D). Primary endpoints were post-operative leaks, bleeding, and stenosis, while secondary outcomes consisted of the time to perform the staple line reinforcement (SLR) and total operative time.Results
Mean SLR operative time was lower for group B (3.4?±?1.3 min) compared with that for groups C (26.8?±?8.5 min) and D (21.1?±?8.4 min) (p?<?0.0001). Mean total operative time was 100.7?±?16.4 min (group A), 104.4?±?22.1 min (group B), 126.2?±?18.9 min (group C), and 124.6?±?22.8 (group D) (p?<?0.0001). Post-operative leaks, bleeding, and stenosis were recorded in 14 pts (2.3 %), 5 pts (0.8 %), and 7 pts (1.1 %), respectively, without statistical difference between the groups.Conclusion
Our study suggests that SLR during LSG, with an imbricating or non-imbricating running suture or with fibrin glue, is an unrewarding surgical act with the sole effect of prolonging the operative time.13.
Christine Stroh D. Birk R. Flade- Kuthe M. Frenken B. Herbig S. Höhne H. Köhler V. Lange K. Ludwig R. Matkowitz G. Meyer P. Pick Th. Horbach S. Krause L. Schäfer M. Schlensak E. Shang T. Sonnenberg M. Susewind H. Voigt R. Weiner S. Wolff A. M. Wolf U. Schmidt H. Lippert Th. Manger 《Obesity surgery》2009,19(5):632-640
Background Beginning January 1, 2005, the status and outcomes of bariatric surgery were examined in Germany. Data are registered in cooperation
with the An-Institute of quality assurance in surgery at the Otto-von-Guericke-University Magdeburg. The objective of this
study was to examine the morbidity and mortality rates secondary to sleeve gastrectomy (SG) in Germany since 2006.
Methods Data collection occurred prospectively in an online data bank. All primary bariatric procedures performed were recorded as
were all re-operations in patients that had already undergone a primary operation. Specific data compiled on the sleeve gastrectomy
procedure were evaluated with a focus on operative details and complication rates.
Results The total study cohort contains 3,122 patients. From January 2006 to December 2007, 144 sleeve gastrectomy procedures were
performed in the 17 hospitals participating in the study. The mean body mass index (BMI) of all patients was 48.8 kg/m2. The BMI of patients undergoing SG was 54.5 kg/m2. In total, 73.8% of the patients were female and 26.2% of the patients were male. There were no significant differences between
patients undergoing SG. The general complication rate after SG was 14.1%, and the surgical complication rate was 9.4%. The
postoperative mortality rate was 1.4%.
Conclusions The complication rate during the first 2 years after SG in Germany is similar to that published in the literature. In order
to improve the quality of bariatric surgery, an evaluation of data from a German multicenter trial is necessary to evaluate
the position of SG in the bariatric algorithm. 相似文献
14.
Fabio Pomerri Mirto Foletto Giorgia Allegro Paolo Bernante Luca Prevedello Pier Carlo Muzzio 《Obesity surgery》2011,21(7):858-863
Background
Laparoscopic sleeve gastrectomy (LSG) is now considered an effective bariatric procedure (American Society for Metabolic and Bariatric Surgery statement). We attempted to assess the size of the gastric fundus remaining after LSG and gastric voiding rate (fast/slow) by radiological upper gastrointestinal series (UGS) with a water-soluble contrast medium (CM). The findings were compared with weight loss data.Methods
Seventy-four obese patients underwent LSG. Radiological UGS were used to measure the remaining fundus size in 28 of 74 patients 24?C72 h after the procedure, with the aid of Matlab software and a library image processing toolbox (MathWorks®). Sleeve voiding was measured in 57 of 74 patients, based on the patients?? radiological reports.Results
The mean volume of the remaining fundus was 17.56 ml (range 1.00?C77.03 ml). The mean percent excess BMI loss (%EBL) was 39.5%, 53.7%, and 60.8%, respectively, 3, 6, and 12 months after LSG. Sleeve voiding was fast in 49 of 57 patients (85.96%) and slow in eight (14.03%).Conclusions
No correlation was found between the estimated volume of the remaining gastric fundus and weight loss (%EBL) after LSG. Patients showing a rapid gastroduodenal transit of the CM achieved a better weight loss than patients with a slow voiding rate. 相似文献15.
Piotr K. Kowalewski Robert Olszewski Maciej S. Walędziak Michał R. Janik Andrzej Kwiatkowski Natalia Gałązka-Świderek Krzysztof Cichoń Jakub Brągoszewski Krzysztof Paśnik 《Obesity surgery》2018,28(1):130-134
Introduction
Sleeve gastrectomy (LSG) is one of the most popular bariatric procedures. We present our long-term results regarding weight loss, comorbidities, and gastric reflux disease.Material and Methods
We identified patients who underwent LSG in our institution between 2006 and 2009. We revised the data, and the patients with outdated contact details were tracked with the national health insurance database and social media (facebook). Each of the identified patients was asked to complete an online or telephone survey covering, among others, their weight and comorbidities. On that basis, we calculated the percent total weight loss (%TWL) and percent excess weight loss (%EWL), along with changes in body mass index (ΔBMI). Satisfactory weight loss was set at >50% EWL (for BMI = 25 kg/m2). We evaluated type 2 diabetes (T2DM) and arterial hypertension (AHT) based on the pharmacological therapy. GERD presence was evaluated by the typical symptoms and/or proton pump inhibitor (PPI) therapy.Results
One hundred twenty-seven patients underwent LSG between 2006 and 2009. One hundred twenty patients were qualified for this study. Follow-up data was available for 100 participants (47 female, 53 male). Median follow-up period reached 8.0 years (from 7.1 to 10.7). Median BMI upon qualification for LSG was 51.6 kg/m2. Sixteen percent of patients required revisional surgery over the years (RS group), mainly because of insufficient weight loss (14 Roux-Y gastric bypass—LRYGB; one mini gastric bypass, one gastric banding). For the LSG (LSG group n = 84), the mean %EWL was 51.1% (±22.3), median %TWL was 23.5% (IQR 17.7–33.3%), and median ΔBMI was 12.1 kg/m2 (IQR 8.2–17.2). Fifty percent (n = 42) of patients achieved the satisfactory %EWL of 50%. For RS group, the mean %EWL was 57.8% (±18.2%) and median %TWL reached 33% (IQR 27.7–37.9%). Sixty-two percent (n = 10) achieved the satisfactory weight loss. Fifty-nine percent of patients reported improvement in AHT therapy, 58% in T2DM. After LSG, 60% (n = 60) of patients reported recurring GERD symptoms and 44% were treated with proton pomp inhibitors (PPI). In 93% of these cases, GERD has developed de novo.Conclusions
Isolated LSG provides fairly good effects in a long-term follow-up with mean %EWL at 51.1%. Sixteen percent of patients require additional surgery due to insufficient weight loss. More than half of the subjects observe improvement in AHT and T2DM. Over half of the patients complain of GERD symptoms, which in most of the cases is a de novo complaint.16.
Felix B. Langer Arthur Bohdjalian Soheila Shakeri-Leidenmühler Sebastian F. Schoppmann Johannes Zacherl Gerhard Prager 《Obesity surgery》2010,20(7):835-840
Background
Due to excellent weight loss success in the short-time follow-up, sleeve gastrectomy (SG) has gained popularity as sole and definitive bariatric procedure. In the long-term follow-up, weight loss failure and intractable severe reflux can necessitate further surgical intervention. 相似文献17.
18.
Melissas J Daskalakis M Koukouraki S Askoxylakis I Metaxari M Dimitriadis E Stathaki M Papadakis JA 《Obesity surgery》2008,18(10):1251-1256
Background Sleeve gastrectomy (SG), which, thus far, is showing good resolution of comorbidities and good weight loss, shows increasing
popularity among bariatric surgeons. The aim of this study was to evaluate clinical outcome and the gastric emptying of solid
foods, 24 months after SG.
Methods Fourteen morbidly obese patients, four males and ten females, median age 41 years (range 29–65), median body mass index (BMI)
49.46 kg/m2 (range 41.14–55.63), who underwent SG for weight loss, were studied prospectively. Nine patients underwent gastric emptying
studies, using radioisotopic technique before, 6 months and 24 months after the operation. The remaining five patients underwent
gastric emptying studies, 6 months and 24 months after the operation.
Results A significant reduction in patients’ weight and BMI was evident at 6, 12 and 24 months postoperatively. In the nine patients
who underwent gastric emptying studies pre-, 6 and 24 months postoperatively, the T-lag phase duration significantly decreased, following the SG, from 17.30 (range 15.50–20.90) min, to 12.50 (range 9.20–18.00) min
at 6 months and 12.16 (range 10.90–20.00) min at 24 months postoperatively (P < 0.05). The gastric emptying half time (T1/2) accelerated significantly postoperatively from 86.50 (range 77.50–104.60) min, to 62.50 (range 46.30–80.00) min at 6 months
and 60.80 (range 54.80–100.00) min at 24 months after SG (P < 0.05). The percentage of gastric emptying (%GE) increased significantly postoperatively, from 52 (range 43–58) % to 72
(range 57–97) % at 6 months and 74 (range 45–82) % at 24 months, following SG (P < 0.05). No differences in gastric emptying were observed, when values at 24 months were compared to those at 6 months postoperatively.
When the whole group of 14 patients was studied, there were also no significant changes in T-lag, T1/2 and %GE between 6 and 24 months postoperatively.
Conclusions Our study indicates the constant effect of SG in the acceleration of gastric emptying of solids, which occurs faster, not
only in short but also in long-term postoperatively. Such effects on gastric motility, in combination with the reported alterations
in gut hormones, may explain how this ‘food limiting’ operation results in weight loss. 相似文献
19.
Adib Abu Hajer Stefanie Wolff Frank Benedix Martin Hukauf Th. Manger Christine Stroh Obesity Surgery Working Group Competence Network Obesity 《Obesity surgery》2018,28(7):1831-1837
Background
The population are getting older and obesity is growing. Laparoscopic sleeve gastrectomy (LSG) is increasingly used worldwide but is still used with skepticism in the elderly. The purpose of our analysis is to judge the security of LSG in patients older than 60 years compared to patients younger than 60 years.Methods
This retrospective review included data of all patients in Germany who underwent LSG between January 2005 and December 2016.The data were published online in the German Bariatric Surgery Registry. A total of 21,571 operations were gathered and divided into two groups: group I, patients <?60 years old; and group II, patients ≥?60 years old.Results
The total number of patients and the mean body mass index of group I and group II was 19,786, 51.7?±?9.5 kg/m2 and 1771, 49.2?±?8.1 kg/m2, respectively. Regarding comorbidities, group II suffered statistically significantly more comorbidities than group I (p?<?0.001). The general postoperative complications were 4.9% in group I and 7.8% in group II (p?<?0.001). There was no significant difference in special postoperative complications (p?=?0.048) and a slightly higher intraoperative complication rate in group II (2.2% vs. 1.6%, p?=?0.048). Thirty-day mortality rate for group I versus II was 0.22% and 0.23% (p?=?0.977), respectively.Conclusions
LSG is a low-risk operation and safe surgical method with acceptable, not elevated perioperative morbidity and mortality rates in patients ≥?60 years of age.20.
Fuks D Dumont F Berna P Verhaeghe P Sinna R Sabbagh C Demuynck F Yzet T Delcenserie R Bartoli E Regimbeau JM 《Obesity surgery》2009,19(2):261-264
Laparoscopic sleeve gastrectomy (LSG) is a new restrictive bariatric procedure increasingly indicated in the treatment of
morbid obesity. Postoperative complications are mainly represented by gastric fistula with an occurrence rate of 0% to 5.1%
in the literature. This complication is difficult to manage and requires multiple radiological, endoscopic, and surgical procedures.
We report herein the case of a 23-year-old woman who underwent LSG for morbid obesity. This patient was reoperated for peritonitis
due to a gastric fistula located on the top of the staple line. Five months later, she complained of a cough with fever and
expectoration. A methylene blue test and a computed tomography scan diagnosed a postoperative bronchogastric fistula. After
failure of aggressive conservative management, radical surgery was performed with total gastrectomy, reconstruction of the
diaphragm using the extended latissimus dorsi flap, and a pulmonary lobectomy. This case report highlights the possible issue
of the complex management of gastric fistula after LSG. 相似文献