Journal of metabolic and bariatric surgery最新文献_第6页

Leaks after sleeve gastrectomy – A narrative review 袖式胃切除术后的渗漏-一个叙述性的回顾

Journal of metabolic and bariatric surgery

Pub Date : 2022-05-01 DOI: 10.4103/jbs.jbs_2_21

N. Jain, R. Bhojwani, K. Mahawar

Background: Laparoscopic sleeve gastrectomy has become a standalone procedure for the treatment of severe obesity with excellent short- and mid-term outcome. Staple-line leak is one of the most dreaded complications of this procedure. Following a standardized sequence of critical steps can help decrease the incidence of leaks. In this review, we examine the etiopathogenesis of leaks after laparoscopic sleeve gastrectomy and important implicated technical considerations. Materials and Methods: A comprehensive literature search of various databases was performed with relevant keywords. The published scientific literature was critically appraised. Results: Patient-, surgery-, and surgeon-related risk factors should be recognized and modifiable risk factors should be addressed. There are anatomical, physiological, and technical considerations that contribute to the pathogenesis of leaks, based on which a multitude of precautions need to be taken to prevent staple-line leak. Conclusion: The correct bougie size, distance from the pylorus, stapler size, orientation of staple line, and distance from angle of His and an intraoperative leak test are some of the crucial aspects for a successful outcome after sleeve gastrectomy. Staple size less than that of 1.5 mm should not be used on the stomach, stapling should be initiated at least 5 cm from pylorus and calibrated on a bougie that should not be <32 Fr size. Reinforcing the staple line reduces the incidence of hemorrhage, and current evidence indicates the incidence of leak. Performing a leak test, though offers less sensitivity to predict a leak, does help in detecting the immediate mechanical failure of staple line.

背景:腹腔镜袖胃切除术已成为治疗重度肥胖的独立手术，具有良好的中短期疗效。钉线泄漏是该手术最可怕的并发症之一。遵循标准化的关键步骤顺序可以帮助减少泄漏的发生率。在这篇综述中，我们检查了腹腔镜袖胃切除术后漏的病因和重要的涉及技术注意事项。材料与方法:采用相关关键词对各数据库进行综合文献检索。发表的科学文献得到了严格的评价。结果:应认识到患者、手术和外科相关的危险因素，并处理可改变的危险因素。有解剖学，生理学和技术方面的考虑，有助于泄漏的发病机制，在此基础上，需要采取多种预防措施，以防止钉线泄漏。结论:选择正确的胃袢大小、距幽门的距离、吻合器的大小、吻合器线的方向、距His角的距离以及术中漏孔试验是保证袖胃切除术成功的关键因素。不应在胃上使用小于1.5毫米的钉钉，钉钉应在距幽门至少5厘米处开始，并在不小于32fr尺寸的钉钉上进行校准。加强钉线可以减少出血的发生，目前的证据表明有泄漏的发生。进行泄漏测试，虽然预测泄漏的灵敏度较低，但确实有助于检测短钉线的即时机械故障。

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引用次数: 1

Management of gastrojejunostomy anastomotic leak post one anastomosis gastric bypass with a covered stent alone 胃空肠吻合术吻合口漏的处理

Journal of metabolic and bariatric surgery

Pub Date : 2022-05-01 DOI: 10.4103/jbs.jbs_6_21

P. Bhatia, H. Sheth, S. Bhatia, S. Baig

Leaks after one anastomosis gastric bypass are managed based on the timing of presentation and the presence or absence of peritonitis. Reoperation is strongly advocated because of the potential severity of biliary peritonitis. Recently, nonoperative treatment is being increasingly employed, especially for staple line disruptions or unspecified leaks. We report successful usage of a covered esophageal stent in a gastrojejunostomy anastomosis leak with a favorable outcome.

一次胃旁路吻合后的渗漏是根据出现的时间和是否存在腹膜炎来处理的。由于胆道性腹膜炎的潜在严重性，再次手术被强烈提倡。最近，非手术治疗越来越多地被采用，特别是对于钉线断裂或未指明的泄漏。我们报告在胃空肠吻合术中成功使用带盖食管支架并获得良好的结果。

引用次数: 0

Thirty-day morbidity and mortality of bariatric and metabolic surgery in patients with type 2 diabetes mellitus: A subset analysis of the GENEVA cohort study 2型糖尿病患者减肥和代谢手术的30天发病率和死亡率:日内瓦队列研究的一个亚组分析

Journal of metabolic and bariatric surgery

Pub Date : 2022-05-01 DOI: 10.4103/jbs.jbs_1_21

R. Singhal, V. Cardoso, C. Ludwig, J. Super, Yashasvi Rajeev, G. Rudge, G. Gkoutos, K. Mahawar, GENEVA collaborators, Ashraf M Shoma

Introduction: There is a paucity of data in the scientific literature on the morbidity and mortality of bariatric and metabolic surgery (BMS) in individuals suffering from Type 2 diabetes mellitus (T2D). The current study is a secondary analysis of the GENEVA dataset to understand this. Materials and Methods: Logistic regressions were performed to investigate the influence of diabetes on complication rates and procedure selection. Ethical approval was not required. Results: One thousand four hundred and seventy-five of these patients were suffering from T2D at the time of the surgery (416 diet-treated type 2 diabetes), 806 oral agent-treated type 2 diabetes, and 253 insulin-treated type 2 diabetes [ITD]). Six hundred and fifty (44.1%) of these patients underwent laparoscopic sleeve gastrectomy (LSG); 487 (33%) underwent Roux-en-Y gastric bypass; 230 (15.6%) underwent a one anastomosis gastric bypass (OAGB); and 108 (7.3%) underwent some other procedures. The 30-day mortality of BMS in those without T2D was 0.07% (4/5609) as compared to 0.4% (6/1475) and 0.8% (2/253) in those with T2D and ITD, respectively. 7.9% of those with T2D developed a 30-day complication compared to 6.5% without T2D (P = 0.0475). There was an increased risk of complications in patients with ITD on univariate and multivariate analysis. Patients with T2D were significantly less likely to undergo an LSG and significantly more likely to undergo an OAGB. Conclusions: ITD patients undergoing BMS experienced significantly higher 30-day morbidity and mortality. Although LSG was the most common procedure in patients with T2D, these patients were less likely to undergo LSG than patients without T2D.

关于2型糖尿病(T2D)患者的减肥和代谢手术(BMS)的发病率和死亡率的科学文献缺乏数据。目前的研究是对日内瓦数据集的二次分析，以理解这一点。材料与方法:采用Logistic回归分析糖尿病对并发症发生率和手术方式选择的影响。不需要伦理批准。结果:其中1475例患者在手术时患有T2D(416例为饮食治疗型2型糖尿病)，806例为口服药物治疗型2型糖尿病，253例为胰岛素治疗型2型糖尿病[ITD])。650例(44.1%)患者行腹腔镜袖式胃切除术(LSG);487例(33%)行Roux-en-Y胃旁路术;230例(15.6%)行单口胃旁路术(OAGB);108例(7.3%)接受了其他手术。无T2D患者BMS的30天死亡率为0.07%(4/5609)，而T2D和ITD患者分别为0.4%(6/1475)和0.8%(2/253)。7.9%的T2D患者出现30天并发症，而没有T2D的患者为6.5% (P = 0.0475)。单因素和多因素分析显示，ITD患者出现并发症的风险增加。T2D患者接受LSG的可能性明显降低，而接受OAGB的可能性明显增加。结论:接受BMS治疗的ITD患者30天的发病率和死亡率明显更高。虽然LSG是T2D患者中最常见的手术，但这些患者比没有T2D的患者更不可能接受LSG。

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引用次数: 0

Medium-Term outcomes after Roux-en-Y-Gastric Bypass: Experience from a Tertiary Healthcare Center from India roux -en- y胃旁路手术的中期结果:来自印度三级医疗中心的经验

Journal of metabolic and bariatric surgery

Pub Date : 2022-05-01 DOI: 10.4103/jbs.jbs_2_22

P. Arumugaswamy, Vitish Singla, S. Aggarwal

Background: Roux en Y gastric bypass (RYGB) has been highly effective in weight loss and it has been the procedure of choice for patients suffering from diabetes. There is a high attrition rate in long-term follow-up. Hence, limited long-term data are available. Methodology: We collected retrospectively data from a prospectively maintained institutional database. To increase the long-term follow-up rate, a telephonic interview was conducted with patients who had not come for long-term follow-up. Standard definitions were used for weight loss, weight regain, comorbidities, comorbidity resolution, and nutritional parameters. Results: Of 142 patients who underwent laparoscopic RYGB between 2008 and 2018, 125 patients (M: 33, F: 92; Age: 42.4 ± 5.2 years) were included in the study. The mean % weight loss at 1, 3, 5, and 7 years was 28.9, 31.8, 31.3, and 31.7, respectively. Mean % excess body mass index loss (% EBMIL) at 1, 3, 5, and 7 years was 67.6 ± 18, 73.7 ± 17.9, 71.7 ± 20.7, and 69.5 ± 24.6, respectively. Median weight regain at 3, 5, and 7 years was 8.4%, 12.7%, and 24% of weight lost. Significant weight regain was seen in 1 patient at 3 years and 3 patients at 5 and 7 years of follow-up. Among patients suffering from diabetes, 50.9% had remission and 45.3% had improvement at 1 year. At 5 years, this was 56% and 40%, respectively. Among patients suffering from hypertension, at 5 years, remission was seen in 11 (64.7%) out of 17. Significant improvements were seen in hypothyroidism, OSA, gastroesophageal reflux disease, and lipid profile. There was a statistically significant decrease in mean levels of fasting blood sugar, glycated hemoglobin (HbA1c), hemoglobin, serum calcium, insulin, c-peptide, serum albumin, and total protein and there was an increase in mean Vitamin D levels at 1 year follow-up. There was a decrease in mean levels of folate, total iron-binding capacity, parathyroid hormone, and alkaline phosphatase and an increase in mean Vitamin B12, iron, and ferritin postsurgery. However, this was statistically not significant. Nutritional deficiencies were noted. Seven complications were noted out of 142 procedures and no surgery-related mortality. Three patients had significant weight regain beyond 5 years. Conclusion: RYGB is a safe and effective bariatric procedure with well-sustained results in long run. Nutritional supplementation is required to correct deficiencies.

背景:Roux en Y胃旁路术(RYGB)在减肥方面非常有效，已成为糖尿病患者的首选手术。在长期随访中有很高的流失率。因此，可获得的长期数据有限。方法:我们从前瞻性维护的机构数据库中收集回顾性数据。为了提高长期随访率，对未来长期随访的患者进行电话访谈。标准定义用于体重减轻、体重恢复、合并症、合并症解决和营养参数。结果:在2008年至2018年期间接受腹腔镜RYGB治疗的142例患者中，125例(男33例，女92例;年龄:42.4±5.2岁)纳入研究。1年、3年、5年和7年的平均体重下降百分比分别为28.9、31.8、31.3和31.7。1年、3年、5年和7年的平均超重体重指数损失率(% ebil)分别为67.6±18、73.7±17.9、71.7±20.7和69.5±24.6。3年、5年和7年的中位体重恢复率分别为8.4%、12.7%和24%。1例患者在3年随访时体重明显回升，3例患者在5年和7年随访时体重明显回升。在患有糖尿病的患者中，50.9%的患者在1年内得到缓解，45.3%的患者得到改善。5年后，这一比例分别为56%和40%。在患有高血压的患者中，17例患者中有11例(64.7%)在5年时得到缓解。甲状腺功能减退、OSA、胃食管反流病和血脂均有显著改善。随访1年后，空腹血糖、糖化血红蛋白(HbA1c)、血红蛋白、血清钙、胰岛素、c肽、血清白蛋白、总蛋白的平均水平均有统计学意义的下降，维生素D的平均水平有所上升。术后叶酸、总铁结合能力、甲状旁腺激素和碱性磷酸酶的平均水平下降，维生素B12、铁和铁蛋白的平均水平上升。然而，这在统计学上并不显著。注意到营养缺乏。142例手术中出现7例并发症，无手术相关死亡。3例患者在5年后体重明显回升。结论:RYGB是一种安全有效的减肥方法，长期效果良好。需要补充营养来纠正缺陷。

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引用次数: 0

Early weight loss: A determinant of total weight loss after bariatric surgery 早期体重减轻:减肥手术后总体重减轻的决定因素

Journal of metabolic and bariatric surgery

Pub Date : 2022-05-01 DOI: 10.4103/jbs.jbs_3_21

Sigin Satheesh, A. Shetty, A. Nasta, Madhu Goel, Ramen Goel

Background: Bariatric surgery is the most effective weight loss intervention for patients with severe obesity. Several studies have shown wide variability in weight loss response between patients. The aim of the study is to identify comparative poor responders based on weight loss in the early postoperative period. Methods: A retrospective analysis of 125 patients who underwent primary bariatric surgery by a single surgeon and completed 1 year of follow-up was performed. Patients were divided into two groups based on % Total Weight loss (%TWL) at 1 month after surgery: Group 1-who lost <10% TWL and Group 2-who lost >10% TWL. The comparison of factors in both groups at different time points was executed using paired t-tests or analysis of variance. The relationships between Group 1 and Group 2 after 1 year follow-up period were assessed through linear regression analyses. Results: Seventy (56%) patients lost <10% TWL and 55 (44%) patients lost more than 10% TWL in 1 month after surgery. Mean weight loss at 1 month and 1 year after surgery was 9 ± 5.5 kg and 37 ± 13.3 kg in Group 1 compared to 16 ± 5.2 and 46 ± 16.4 kg in Group 2, respectively. Patients with >10%TWL at 1 month had significantly greater %TWL at 1 year (P = 0.001). Linear regression analysis showed a positive correlation between patients who lost >10%TWL 1 month after surgery and weight loss at 1 year. Conclusion: Postoperative percentage TWL of <10% at 1 month can be used as an early determinant of comparatively poor weight loss at 1 year. Early initiation of aggressive and multimodal treatment strategies is likely to improve overall weight loss outcomes after surgery.

背景:减肥手术是重度肥胖患者最有效的减肥干预手段。几项研究表明，患者之间的减肥反应存在很大差异。该研究的目的是确定术后早期体重减轻的相对不良反应者。方法:回顾性分析125例接受单一外科医生的原发性减肥手术并完成1年随访的患者。根据术后1个月总体重减轻% (%TWL)将患者分为两组:第一组，总体重减轻10% TWL。两组在不同时间点的因素比较采用配对t检验或方差分析。1年随访期后，通过线性回归分析评价1组与2组之间的关系。结果:70例(56%)患者1个月时TWL下降10%，1年时TWL明显增加(P = 0.001)。线性回归分析显示，术后1个月twl下降>10%的患者与术后1年体重下降呈正相关。结论:术后1个月TWL <10%的百分比可作为1年体重减轻相对较差的早期决定因素。早期开始积极和多模式的治疗策略可能会改善手术后的整体减肥结果。

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引用次数: 0

Gastric bypass: Historical evolution and technical development of a time-honored bariatric procedure 胃旁路:历史演变和技术发展的一个历史悠久的减肥程序

Journal of metabolic and bariatric surgery

Pub Date : 2022-05-01 DOI: 10.4103/jbs.jbs_7_21

Eduardo Bastos, D. Pajecki

Gastric bypass (GB) was originally described over 50 years ago as an alternative to jejunoileal bypass in the surgical approach to morbid obesity. Since then, several technical improvements and modifications have been proposed over time to simplify technical execution, enhance outcomes, and minimize the risk of complications and/or adverse effects. After half a century of robust and sustained results, the technical drawing of the GB still undergoes improvements, mainly to ensure even more safety for obese patients and encompass modern concepts of metabolic surgery. This review aims to outline the main technical changes proposed for GB from its original description to the current times.

胃旁路(GB)最初是在50多年前被描述为一种替代空肠回肠旁路的手术方法，用于治疗病态肥胖。从那时起，随着时间的推移，提出了一些技术改进和修改，以简化技术执行，提高结果，并最大限度地减少并发症和/或不良反应的风险。经过半个世纪的稳健和持续的成果，GB的技术图纸仍在不断改进，主要是为了确保肥胖患者更加安全，并包含现代代谢手术的概念。本综述旨在概述从原始描述到当前时代对GB提出的主要技术变化。

引用次数: 0

Gastric remnant shape following laparoscopic sleeve gastrectomy correlates with weight loss: A retrospective cohort study 腹腔镜袖式胃切除术后胃残体形状与体重减轻相关:一项回顾性队列研究

Journal of metabolic and bariatric surgery

Pub Date : 2022-05-01 DOI: 10.4103/jbs.jbs_1_22

D. Jobson, Julia Freckelton, Melanie K Seale, L. Chong, Nicole N. Winter, M. Read, S. Ward, M. Hii

Background: Laparoscopic sleeve gastrectomy (LSG) is a safe and effective bariatric surgical procedure. Sleeve configuration is believed to be an important outcome of good operative technique, yet the relationship of sleeve shape to clinical outcomes including weight loss and postoperative symptoms is not clearly defined. This study aims to identify whether gastric remnant anatomical shape is associated with short-term postoperative weight loss or symptoms of reflux, regurgitation, or dysphagia. Methods: 207 LSG patients were identified from a prospective, multicentre unit database who had surgery between June 2015 and June 2019. Routine postoperative upper gastrointestinal gastrograffin contrast studies were performed between postoperative days one to five and analyzed using a standardized protocol. Gastric remnant shape was classified as either tubular, proximal pouch or distal pouch consistent with previous studies. ANOVA Kruskal − Wallis and Mann − Whitney U-tests were performed to determine the effect of gastric remnant anatomy on weight loss. Descriptive statistics examined the symptoms of reflux, regurgitation, and dysphagia. Results: Gastric remnant anatomy was classified as tubular in 159/207 (78%), proximal pouch in 15/207 (7%), and distal pouch in 33/207 (16%). Patients with a tubular shape had a significantly greater reduction in median body mass index at 12 months postoperatively compared to those with a proximal pouch (11.3 kg/m2 vs. 10.2 kg/m2, P = 0.01). There was no relationship identified between gastric remnant shape and postoperative reflux, regurgitation, or dysphagia. Conclusion: A tubular-shaped gastric remnant is associated with increased weight loss. This suggests that tubular shape should be considered the desired LSG shape for greatest weight loss.

背景:腹腔镜袖胃切除术(LSG)是一种安全有效的减肥手术。袖形被认为是良好手术技术的重要结果，但袖形与临床结果(包括体重减轻和术后症状)的关系尚不明确。本研究旨在确定残胃解剖形状是否与术后短期体重减轻或反流、反流或吞咽困难症状相关。方法:从2015年6月至2019年6月期间接受手术的前瞻性多中心单元数据库中确定207例LSG患者。术后1 - 5天进行常规上消化道胃涂鸦对比研究，并采用标准化方案进行分析。残胃形态分为管状、近端袋状和远端袋状，与以往研究一致。采用方差分析Kruskal - Wallis和Mann - Whitney u检验来确定残胃解剖对减肥的影响。描述性统计检查了反流、反流和吞咽困难的症状。结果:残胃解剖分类为管状159/207(78%)，近端袋15/207(7%)，远端袋33/207(16%)。术后12个月，管状肾囊患者的中位体重指数比近端肾囊患者明显降低(11.3 kg/m2 vs 10.2 kg/m2, P = 0.01)。未发现残胃形状与术后反流、反流或吞咽困难之间的关系。结论:胃管状残余与体重减轻有关。这表明管状形状应该被认为是理想的LSG形状，以达到最大的减重效果。

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引用次数: 0

A journey of a thousand miles begins with a single step 千里之行，始于足下

Journal of metabolic and bariatric surgery

Pub Date : 2022-05-01 DOI: 10.4103/jbs.jbs_3_22

P. Chowbey, Ramen Goel, K. Mahawar

引用次数: 0

Early Clinical Outcomes of the Morbidly Obese Patients Who Underwent Laparoscopic Sleeve Gastrectomy by Gastric Cancer Surgeons: the Analysis of Fifty Consecutive Cases. 50例连续胃癌外科医生行腹腔镜袖式胃切除术的病态肥胖患者的早期临床结果分析

Journal of metabolic and bariatric surgery

Pub Date : 2021-12-01 DOI: 10.17476/jmbs.2021.10.2.66

Chang Seok Ko, Jin Ho Jheong, Seong-A Jeong, Chung Sik Gong, In-Seob Lee, Beom Su Kim, Byung Sik Kim, Hye Soon Park, Se Hee Min, Moon-Won Yoo

Purpose: The number of bariatric surgeries performed at our tertiary hospital has gradually increased since the national health insurance began to cover their expenses in January of 2019. This study examined the early surgical outcomes of laparoscopic sleeve gastrectomy (LSG) performed by experienced gastric cancer surgeons.

Materials and methods: We retrospectively reviewed and analyzed data from 50 patients who underwent LSG between November of 2018 and April of 2020 at the Asan Medical Center by 1 of 5 experienced surgeons each of whom performed approximately 100-300 cases of gastrectomy annually. The age, body mass index (BMI), weight, presence of comorbidities, operation time, hospital stay after surgery, postoperative complications, postoperative excess weight loss (EWL), and resolution of comorbidities were examined.

Results: The mean age, BMI, and weight were 37.29±9.77 years, 37.12 kg/m², and 102.00 kg, respectively. The mean operation time and postoperative length of hospital stay were 109.59±35.88 and 5.06±1.20 days, respectively. Two patients (4.00%) had early postoperative complications and postoperative leakage; bleeding and stenosis were not reported. The EWL after 1 and 6 months of operation was 26.55% and 60.34%, respectively. The resolution of diabetes, hypertension, and dyslipidemia after 6 months of operation was 88.89%, 54.54%, and 50.00%, respectively.

Conclusion: LSG is safe and effective when performed by an experienced gastric cancer surgeon; however, a long-term follow-up of patients is required.

目的:自2019年1月国民健康保险开始承担减肥手术费用以来，我院三级医院的减肥手术数量逐渐增加。本研究探讨了由经验丰富的胃癌外科医生进行的腹腔镜袖胃切除术(LSG)的早期手术效果。材料和方法:我们回顾性地回顾和分析了2018年11月至2020年4月期间在峨山医疗中心接受LSG手术的50名患者的数据，由5名经验丰富的外科医生中的1名进行，每位外科医生每年进行约100-300例胃切除术。检查年龄、体重指数(BMI)、体重、合并症的存在、手术时间、术后住院时间、术后并发症、术后体重减轻(EWL)和合并症的缓解情况。结果:患者平均年龄37.29±9.77岁，BMI为37.12 kg/m2，体重为102.00 kg。平均手术时间109.59±35.88天，平均住院时间5.06±1.20天。术后早期并发症及术后渗漏2例(4.00%);没有出血和狭窄的报道。术后1个月和6个月的EWL分别为26.55%和60.34%。术后6个月糖尿病、高血压和血脂异常的治愈率分别为88.89%、54.54%和50.00%。结论:由经验丰富的胃癌外科医生实施LSG是安全有效的;然而，需要对患者进行长期随访。

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引用次数: 0

Simultaneous Complex Incisional Hernia Repair and Bariatric Surgery for Obese Patients: a Case Series of a Single-Center Early Experience. 同时复杂切口疝修补和肥胖患者的减肥手术:单中心早期经验的病例系列。

Journal of metabolic and bariatric surgery

Pub Date : 2021-12-01 DOI: 10.17476/jmbs.2021.10.2.55

Juan Carlos Sebastián-Tomás, José Ángel Díez-Ares, Nuria Peris-Tomás, Sergio Navarro-Martínez, Dolores Periañez-Gómez, Álvaro Pérez-Rubio, Ezequiel Martínez-Mas, Ramón Trullenque-Juan

Purpose: Obesity is associated with recurrence of complex incisional hernia repair (CIHR). Bariatric procedure during CIHR can improve recurrence rates without increasing morbidity. This study aimed to describe our results after CIHR in patients with obesity, in which a simultaneous bariatric procedure was performed.

Materials and methods: We performed a retrospective observational study including patients who underwent surgery between January 2014 and December 2018, with a complex incisional hernia (CIH) according to the Slater classification and body mass index (BMI) ≥35. CIHR was the main indication for surgery. We collected demographic data, comorbidities, CIH classification according to the European Hernia Society, type of bariatric procedure, postoperative morbidity using the Dindo-Clavien classification, and short-term results. Computed tomography (CT) is performed preoperatively.

Results: Ten patients were included in the study (7 women). The mean BMI was 43.63±4.91 kg/m². The size of the abdominal wall defect on CT was 8.86±3.93 cm. According to the European Hernia Society classification, all CIHs were W2 or higher. Prosthetic repair of the CIH was selected. Onlay, sublay, preperitoneal, and inlay mesh placement were performed twice each, as well as one modified component separation technique and one transversus abdominis release. Gastric leak after sleeve gastrectomy was the only major complication. Short-term outcomes included one recurrence, and % total weight loss was 24.04±8.03 after 1-year follow-up.

Conclusion: The association of bariatric procedures during CIHR seems to be feasible, safe, and could be an option for surgical treatment in selected patients.

目的:肥胖与复杂切口疝修补术(CIHR)复发相关。CIHR期间的减肥手术可以提高复发率而不增加发病率。本研究旨在描述肥胖患者CIHR后的结果，其中同时进行了减肥手术。材料和方法:我们进行了一项回顾性观察研究，纳入了2014年1月至2018年12月接受手术的患者，根据Slater分类，体重指数(BMI)≥35，患有复杂切口疝(CIH)。CIHR是手术的主要指征。我们收集了人口统计数据、合并症、根据欧洲疝学会的CIH分类、减肥手术类型、使用Dindo-Clavien分类的术后发病率和短期结果。术前进行计算机断层扫描(CT)。结果:共纳入10例患者(女性7例)。平均BMI为43.63±4.91 kg/m2。CT显示腹壁缺损大小为8.86±3.93 cm。根据欧洲疝学会的分类，所有CIHs均为W2或更高。选择假体修复CIH。嵌片、下片、腹膜前和嵌片各放置2次，以及1次改良成分分离技术和1次腹侧释放。套筒胃切除术后胃漏是唯一的主要并发症。短期结果包括1例复发，1年随访后总体重减轻%为24.04±8.03。结论:CIHR期间减肥手术的关联似乎是可行的，安全的，并且可以在选定的患者中作为手术治疗的选择。

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引用次数: 1