Research progress and experience of diagnosis and treatment of gastric leakage after laparoscopic sleeve gastrectomy

doi:10.3877/cma.j.issn.2095-9605.2023.01.011

Abstract

Abstract:

Laparoscopic sleeve gastrectomy (LSG) is an crucial surgical procedure for treating metabolic diseases such as obesity and type 2 diabetes mellitus (T2DM) due to relatively simple procedure and definite effect. But, increasing complications, including gastric leakage, hemorrhage andstenosis, have been reported with widespread application. Especially the gastric leakage, unseasonal diagnosed and invalid treatment frequently results prolonged-hospital, protracted course of disease, more hospitalization expenses, or even sepsis, multiple systemic organ failure (MSOF) and death. Hereon, author summarized the diagnosis and treatment of gastric leakage after LSG derived from present research and team experience, and hope to provide worthy diagnosis and treatment.

Key words: Laparoscopic sleeve gastrectomy, Gastric leakage, Diagnosis and treatment experience, Prevention and control measures, Risk factor

Erdong Mao, Jinwei Yang, Bian Wu, Yun Shang. Research progress and experience of diagnosis and treatment of gastric leakage after laparoscopic sleeve gastrectomy[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(01): 55-61.

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References 53

[1]	Wang Y, Wang L, Qu W, et al.New national data show alarming increase in obesity and noncommunicable chronic diseases in China [J]. European Journal of Clinical Nutrition, 2016, 71(1): 149-150.
[2]	中国居民营养与慢性病状况报告(2020年) [J]. 营养学报, 2020, 42(6): 521.
[3]	王友发, 孙明晓, 薛宏, 等. 《中国肥胖预防和控制蓝皮书》解读及中国肥胖预防控制措施建议 [J]. 中华预防医学杂, 2019, 53(9): 875-884.
[4]	Mahawar KK, Omar I, Singhal R, et al. The first modified Delphi consensus statement on sleeve gastrectomy [J]. Surgical Endoscopy, 2021, 35(12): 7027-7033.
[5]	Chung AY, Thompson R, Overby DW, et al. Sleeve Gastrectomy: Surgical Tips [J]. J Laparoendosc Adv Surg Tech A, 2018, 28(8): 930-937.
[6]	朱利勇, 嵇光年, 孙许龙, 等. 从术式变迁看减重代谢外科发展趋势 [J]. 中国实用外科杂志, 2019, 39(04): 316-321.
[7]	Carlsson LMS, Jacobson P, Peltonen M. Life expectancy after bariatric surgery—the Swedish obese subjects study reply [J]. N Engl J Med, 2021, 384(1): 89.
[8]	Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders(IFSO) indications for metabolic and bariatric surgery [J]. Obes Surg, 2023, 33(1): 3-14.
[9]	Mingrone G, Panunzi S, De Gaetano A, et al. Metabolic surgery versus conventional medical therapy in patients with type 2 diabetes: 10-year follow-up of an open-label, single-centre, randomised controlled trial [J]. Lancet, 2021, 397(10271): 293-304.
[10]	杨华, 陈缘, 董志勇, 等. 中国肥胖代谢外科数据库: 2020年度报告 [J/CD]. 中华肥胖与代谢病电子杂志, 2021, 7(1): 1-7.
[11]	中国医师协会外科医师分会肥胖和糖尿病外科医师委员会, 中国肥胖代谢外科研究协作组．中国肥胖代谢外科数据库：2021年度报告 [J/CD]. 中华肥胖与代谢病电子杂志, 2022, 8(1): 15-23.
[12]	田峰, 杨晓平, 吴建林, 等. 腹腔镜袖状胃切除术后胃漏2例诊疗体会 [J].腹腔镜外科杂志, 2019, 24(6): 405-409.
[13]	Aurora AR, Khaitan L, Saber AA, et al. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients [J]. Surgical Endoscopy, 2012, 26(6): 1509-1515.
[14]	Mocanu V, Marcil G, Dang JT, et al. Preoperative weight loss is linked to improved mortality and leaks following elective bariatric surgery: an analysis of 548 597 patients from 2015-2018 [J]. Surg Obes Relat Dis, 2021, 17(11): 1846-1853.
[15]	中华医学会外科学分会甲状腺及代谢外科学组, 中国医师协会外科医师分会肥胖和糖尿病外科医师委员会. 中国肥胖及2型糖尿病外科治疗指南(2019版) [J]. 中国实用外科杂志, 2019, 39(4): 301-306.
[16]	Rosenthal RJ, Diaz AA, Arvidsson D, et al. International Sleeve Gastrectomy Expert Panel Consensus Statement: best practice guidelines based on experience of >12,000 cases [J]. Surgery for Obesity and Related Diseases, 2012, 8(1): 8-19.
[17]	Sakran N, Goitein D, Raziel A, et al. Gastric leaks after sleeve gastrectomy: a multicenter experience with 2,834 patients [J]. Surgical Endoscopy, 2013, 27(1): 240-245.
[18]	Simon F, Siciliano I, Gillet A,et al.Gastric Leak After Laparoscopic Sleeve Gastrectomy: Early Covered Self-Expandable Stent Reduces Healing Time [J]. Obesity Surgery, 2013, 23(5): 687-692.
[19]	沈海玉. 腹腔镜袖状胃切除术后胃漏诊治的研究进展 [J/CD]. 中华肥胖与代谢病电子杂, 2018, 4(1): 48-51.
[20]	Ruiz-Tovar J, Muñoz JL, Gonzalez J,et al.C-reactive protein, fibrinogen, and procalcitonin levels as early markers of staple line leak after laparoscopic sleeve gastrectomy in morbidly obese patients within an Enhanced Recovery After Surgery (ERAS) program [J]. Surgical Endoscopy, 2017, 31(12): 5283-5288.
[21]	刘金钢, 张忠涛, 王存川, 等. 腹腔镜胃袖状切除术后胃漏诊断、预防及处理中国专家共识(2021版) [J]. 中国实用外科杂志, 2021, 41(6): 633-638.
[22]	Sakran N, Zakeri R, Madhok B, et al. Gastric Fistula in the Chest After Sleeve Gastrectomy: a Systematic Review of Diagnostic and Treatment Options [J]. Obesity Surgery, 2021, 31(1): 357-369.
[23]	Alkhatiba SG, Levineb MS.Gastrobronchial fistula after sleeve gastrectomy: clinical and radiographic findings [J]. Clinical Imaging, 2019, 53: 112-114.
[24]	Zanotti D, Elkalaawy M, Mohammadi B, et al. Gastro-cutaneous fistula 4 years after a fully resolved staple line leak in sleeve gastrectomy [J]. Journal of surgical case reports, 2015, 2015(12): 152.
[25]	Parmar CD, Khalil H, Lakdawala M, et al. Gastro-Colic Fistula After Sleeve Gastrectomy Leak: Our Experience with this Rare Complication [J]. Obesity Surgery, 2019, 29(4): 3771-3772.
[26]	Alizadeh RF, Li S, Inaba C, et al. Risk Factors for Gastrointestinal Leak after Bariatric Surgery: MBASQIP Analysis [J]. Journal of the American College of Surgeons, 2018, 227(1): 135-141.
[27]	Husain F, Jeong IH, Spight D, et al. Risk factors for early postoperative complications after bariatric surgery [J]. Annals of Surgical Treatment Research, 2018, 95(2): 100-110.
[28]	张光辉, 王存川. 中国肥胖及2型糖尿病外科治疗指南(2019版)解读 [J]. 临床外科杂志, 2020, 28(1): 46-48.
[29]	Huang R, Gagner MA. Thickness Calibration Device Is Needed to Determine Staple Height and Avoid Leaks in Laparoscopic Sleeve Gastrectomy [J]. Obesity surgery, 2015, 25(12): 2360-2367.
[30]	Wu C, Wang FG, Yan WM, et al. Is There Necessity for Oversewing the Staple Line During Laparoscopic Sleeve Gastrectomy? An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials [J]. Journal of Investigative Surgery, 2020, 33(9): 839-850.
[31]	刘雁军, 张元川, 杨华武, 等. 腹腔镜袖状胃切除术后8例胃漏临床分析 [J/CD]. 中华肥胖与代谢病电子杂, 2019, 5(4): 191-195.
[32]	Cuadrado A M, Franco HR, Lago OJ. Succesful management of laparoscopic sleeve gastrectomy leak with negative pressure therapy [J]. Obesity Surgery, 2017, 27(9): 2452-2453.
[33]	丁睿, 薛跃进, 杨雁灵, 等. 腹腔镜袖状胃切除术后胃漏的预防与治疗策略 [J]. 中华消化外科杂, 2020, 19(11): 1154-1158.
[34]	赵耀华, 熊伟, 袁东亮, 等. 臭氧水冲洗在感染创面治疗中的应用 [J/CD]．中华损伤与修复杂志：电子, 2017, 12(6): 437-440．
[35]	单晓东, 孙喜太, 褚薛慧, 等. 内镜OTSC吻合夹治疗袖状胃术后难治性胃漏一例报道 [J/CD]. 中华肥胖与代谢病电子杂志, 2019, 5(4): 225-227.
[36]	Kobara H, Mori H, Nishiyama N, et al. Over-the-scope clip system: A review of 1517 cases over 9 years [J]. Gastroenterol Hepatol, 2019, 34(1): 22-30.
[37]	Spicka P. Staple line leak with peritonitis after laparoscopic sleeve gastrectomy - a solution in one to six steps [J]. Bariatric Surgery, 2017, 12(2): 154-159.
[38]	Tringali A, Bove V, Perri V, et al. Endoscopic treatment of postlaparoscopic sleeve gastrectomy leaks using a specifically designed metal stent [J]. Endoscopy, 2017, 49(1): 64-68.
[39]	Carroll J, Kwok M, Patel B,et al. Revision gastric bypass after laparoscopic adjustable gastric band: a 10-year experience at a public teaching hospital [J]. ANZ J Surg, 2018, 88(5): E361-E365.
[40]	Benois M, Sebastianelli L, Morisot A, et al. Revisional but not conversional gastric bypass surgery increases the risk of leaks: review of 176 redo out of 932 consecutive cases [J]. Obes Surg, 2018, 28(9): 2903-2911.
[41]	朱晒红, 李鹏洲, 高祥, 等. 腹腔镜减重代谢袖状胃手术要点与适应证 [J/CD]. 中华普外科手术学杂志:电子, 2020, 14(2): 113-116.
[42]	殷国志, 拓航, 杨威, 等. 腹腔镜袖状胃切除联合胰腺体尾部切除及脾切除术后2月胃漏的诊治 [J/CD]. 中华肥胖与代谢病电子杂志, 2020, 6(2): 135-139.
[43]	Bhalla S, Yu JX, Varban OA, et al. Upper gastrointestinal series after sleeve gastrectomy is unnecessary to evaluate for gastric sleeve stenosis [J]. Surg Endosc, 2021, 35(2): 631-635.
[44]	林湘杰, 李闯, 樊敬文, 等. 加固钉合线预防腹腔镜胃袖状切除术并发症的研究现状 [J]. 腹部外科, 2022, 35(5): 370-374.
[45]	Fort JM, Gonzalez O, Caubet E, et al. Management of the staple line in laparoscopic sleeve gastrectomy: comparison of three different reinforcement techniques[J].Surg Endosco, 2021, 35(7):3354-3360.
[46]	王兵, 严同, 罗丹, 等. 3次胃塑形技术在腹腔镜袖状胃切除术中的应用体会 [J]. 中国普外基础与临床杂志, 2023, 30(3): 264-267.
[47]	Lin Y, Long Y, Lai S, et al. The effectiveness and safety of barbed sutures in the bariatric surgery: a systematic review and metaanalysis [J]. Obes Surg, 2019, 29(6): 1756-1764.
[48]	Batman B, Altun H. Benefits of suture reinforcement in laparoscopic sleeve gastrectomy[J].Surg Laparosc Endosc Percutan Tech, 2019, 29(6): 539-542.
[49]	董志勇, 王华曦, 姜舒文, 等. 三孔"七步法"腹腔镜袖状胃切除术 [J]. 中华胃肠外科杂志, 2020, 23(7): 628.
[50]	董志勇, 王存川. 膜解剖理念在腹腔镜袖状胃切除术中的应用 [J].中华胃肠外科杂志, 2020, 23(7): 661-665.
[51]	Fouad MMB, Ibraheim SMN, Ibraheim P, et al. Assessment of the role of omentopexy in laparoscopic sleeve gastrectomy: A tertiary center experience [J]. Laparoendosc Adv Surg Tech A, 2022, 32(9): 962-968.
[52]	朱江帆. 腹腔镜胃袖状切除术有必要做胃切缘加强吗? [J]. 腹部外科, 2022, 35(3): 150-152.
[53]	Frosio F, Suhool A, Ferraz JM, et al. Anatomical quality criteria for sleeve gastrectomy [J]. Obes Surg, 2021, 31(4): 1541-1548.

分类依据	分类	具体内容
病因	机械性胃漏	术后48~72 h内，主要由技术错误、钉仓选择不当、医源性损伤和远端梗阻等原因导致
	缺血性胃漏	术后5 d出现的胃漏
时间^[16]	急性	术后1周内
	早期	术后1~6周
	晚期	术后6~12周
	慢性	术后12周后
位置^[17,18]	近端^①
	中部
	远端
	胃后壁
	无法定位
临床及影像学表现^[19,20]	A型	无明显临床及影像学表现（微小漏口）
	B型	无明显临床表现但影像学检查确诊
	C型	明显临床表现及典型影像学特征
临床表现及扩散程度^[21]	Ⅰ型（亚临床型）	胃漏局限，无特殊临床及影像表现
	Ⅱ型（临床型）	胃漏扩散，引流管有造影剂甚至出现全身症状
特殊类型	胃胸腔漏	漏口与胸腔相通^[22,23]
	胃皮肤漏	漏口与皮肤相通^[24]
	胃结肠漏^②	漏口与结肠相通

分类依据	分类	具体内容
病因	机械性胃漏	术后48~72 h内，主要由技术错误、钉仓选择不当、医源性损伤和远端梗阻等原因导致
	缺血性胃漏	术后5 d出现的胃漏
时间^[16]	急性	术后1周内
	早期	术后1~6周
	晚期	术后6~12周
	慢性	术后12周后
位置^[17,18]	近端^①
	中部
	远端
	胃后壁
	无法定位
临床及影像学表现^[19,20]	A型	无明显临床及影像学表现（微小漏口）
	B型	无明显临床表现但影像学检查确诊
	C型	明显临床表现及典型影像学特征
临床表现及扩散程度^[21]	Ⅰ型（亚临床型）	胃漏局限，无特殊临床及影像表现
	Ⅱ型（临床型）	胃漏扩散，引流管有造影剂甚至出现全身症状
特殊类型	胃胸腔漏	漏口与胸腔相通^[22,23]
	胃皮肤漏	漏口与皮肤相通^[24]
	胃结肠漏^②	漏口与结肠相通

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