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首页> 外文期刊>Surgical Endoscopy >Laparoscopic remnant gastrectomy as a novel approach for treatment of gastrogastric fistula.
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Laparoscopic remnant gastrectomy as a novel approach for treatment of gastrogastric fistula.

机译：腹腔镜残胃切除术作为治疗胃瘘的一种新方法。

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BACKGROUND: Gastrogastric fistula (GGF) is a rare complication after divided Roux-en-Y gastric bypass (RYGBP). The incidence can be as high as 49% in patients who undergo nondivided or partially divided RYGBP. We have previously reported a GGF rate of 1.5% after divided RYGBP. Remnant gastrectomy has been advocated by our group as a treatment option for this complication. We report our initial experience using the laparoscopic approach. METHODS: After IRB approval and following HIPAA guidelines, we conducted a retrospective review of prospectively collected database of 1,796 patients who underwent RYGB from 2001 and to 2008 at the Bariatric and Metabolic Institute. Data included mean time to laparoscopic remnant gastrectomy (LRG), mean length of hospital stay, follow-up period after laparoscopic remnant gastrectomy, rate of conversion, type of procedure performed, and early and late postoperative complications. RESULTS: Twenty-one (1.1%) patients have been diagnosed with GGF; 11 more patients were admitted with GGF after undergoing initial RYGB at another institution. All patients (n = 32) were initially treated with sucralfate and proton pump inhibitors, and 22 of 32 patients eventually underwent LRG: 1 underwent fistulectomy, 1 underwent conversion of vertical banded gastroplasty to RYGB, and the remaining 8 patients have undergone only medical treatment. The mean time to LRG was 9 months from the time of diagnosis of GGF. Two of the 22 patients had conversion to an open approach: one because of a loss of poor visual surgical field resulting from excessive intraluminal air from intraoperative endoscopy and the other as a result of the inability to understand the anatomy laparoscopically. Three of the 22 patients (13%) underwent LRG and redo gastrojejunostomy because of a stenosed gastrojejunostomy. The mean hospital stay after LRG was 4.7 (range, 3-8) days. Early postoperative complications included intra-abdominal bleeding, pneumonia, wound infections, and fever of unknown origin. Late complications included intra-abdominal abscess, wound infections, fever, and food impactation. The follow-up period after LRG was an average of 4 (range, 1-11) months. During the follow-up period, there was no evidence of marginal ulceration, bleeding, abdominal pain, or recurrence of the GGF in any patient. CONCLUSIONS: Laparoscopic remnant gastrectomy seems to be a safe and effective treatment option for patients with GGF after RYGBP.
机译：背景：胃瘘（GGF）是分割Roux-en-Y胃搭桥术（RYGBP）后的一种罕见并发症。接受未分割或部分分割的RYGBP的患者中发生率可能高达49％。之前我们曾报道，除RYGBP外，GGF率为1.5％。我们小组提倡残余胃切除术作为这种并发症的治疗选择。我们报告了使用腹腔镜方法的初步经验。方法：在IRB批准并遵循HIPAA指南后，我们对肥胖和代谢研究所2001年至2008年接受RYGB治疗的1796例患者进行了回顾性回顾性研究。数据包括平均腹腔镜残胃切除术（LRG）时间，平均住院时间，腹腔镜残胃切除术后的随访时间，转化率，手术类型以及术后早期和晚期并发症。结果：二十一（1.1％）患者被诊断出患有GGF;在另一家机构接受初次RYGB治疗后，又有11名患者被GGF收治。所有患者（n = 32）最初均接受硫糖铝酸盐和质子泵抑制剂治疗，在32位患者中最终有22位接受了LRG：1位接受了瘘管切除术，1位接受了垂直带状胃成形术转化为RYGB，其余8位仅接受了药物治疗。从诊断GGF开始，平均到达LRG的时间为9个月。 22例患者中有2例转换为开放式方法：一种是由于术中内窥镜检查导致腔内空气过多导致手术视野不佳，另一种是因为无法通过腹腔镜了解解剖结构。 22名患者中有3名（13％）由于狭窄的胃空肠吻合术而进行了LRG和重做胃空肠吻合术。 LRG后的平均住院天数为4.7（3-8天）。术后早期并发症包括腹腔内出血，肺炎，伤口感染和不明原因的发烧。晚期并发症包括腹腔内脓肿，伤口感染，发烧和食物受累。 LRG之后的平均随访时间为4（1-11）个月。在随访期间，没有任何患者出现边缘溃疡，出血，腹痛或GGF复发的迹象。结论：RYGBP术后GGF患者腹腔镜残胃切除术似乎是一种安全有效的治疗选择。

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