Leaks after laparoscopic sleeve gastrectomy: 2024 update on risk factors.

IF 2.1 3区医学 Q2 SURGERY

Langenbeck's Archives of Surgery Pub Date : 2024-08-13 DOI:10.1007/s00423-024-03424-7

Angelo Iossa, Lorenzo Martini, Francesco De Angelis, Alessandra Micalizzi, Brad Michael Watkins, Gianfranco Silecchia, Giuseppe Cavallaro

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引用次数: 0

Abstract

Purpose: Leaks after sleeve gastrectomy remain a deadly complication significantly affecting outcomes and medical costs. The aim of the present review is to provide an updated decalogue on leak prevention.

Methods: Risk factors of leakage after LSG were examined based on an extensive review of literature (in period time 2016-2024) and summary of evidence was provided using Oxford levels of evidence scale.

Results: Pathogenesis of leakage after LSG still remain related to ischemic and mechanical factors and, therefore, no new evidence has been reported. Conversely, some technical aspect of the procedure has changed: bougie size, antrum resection, staple line reinforcement, and intraoperative leak testing.

Conclusions: Bougie size 36 F is effective and safe achieving similar leakage rate compared to larger bougie sizes (EL:2) 2024 UPDATE; There is no significant difference in the leak rate between restrictive (< 6 cm) and conservative (6 cm) antrum resection (EL: 1) 2024 UPDATE; Surgical experience and case volume affect the leak rate more consistently than every kind of SLR (EL: 2) 2024 UPDATE; Intraoperative leak test after LSG represents a decision based on surgeon preference in absence of standardization (endoscopy, bubble test, methylene blue, indocyanine green.) and strong detection/prevention rate (EL: 3) 2024 UPDATE.

查看原文本刊更多论文

腹腔镜袖带胃切除术后渗漏：2024 年风险因素更新。

目的：袖状胃切除术后渗漏仍是一种致命的并发症，严重影响治疗效果和医疗成本。本综述旨在提供最新的渗漏预防指南：方法：在广泛查阅文献（2016-2024 年）的基础上，对 LSG 术后渗漏的风险因素进行研究，并采用牛津证据等级表对证据进行总结：结果：LSG术后渗漏的发病机制仍与缺血和机械因素有关，因此没有新的证据报道。相反，手术的某些技术方面发生了变化：套管尺寸、胃窦切除、缝合线加固和术中渗漏检测：与更大尺寸的开口器（EL:2）2024 UPDATE 相比，36 F 尺寸的开口器既有效又安全，达到了相似的漏损率；限制性开口器（EL:2）2024 UPDATE 和限制性开口器（EL:2）2024 UPDATE 之间的漏损率没有显著差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.