Laparoscopic sleeve gastrectomy: a single-center experience with 1 568 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

CHEN Jionghuang ¹ , PU Xiaofan ¹ , CAI Xuyan ¹ , SHEN Hongdan ² , ZHENG Sufen ² ,  YU Weihua ¹

1. Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310009, P. R. China;
2. Department of Nursing, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310009, P. R. China;

Corresponding author：

YU Weihua, Email: srrshwhy@zju.edu.cn

Keywords：

laparoscopic sleeve gastrectomy; bariatric and metabolic surgery; single-center experience

DOI：

10.7507/1007-9424.202508128

Video：

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Objective To evaluate the weight loss outcomes, metabolic disease remission, and complication profiles of laparoscopic sleeve gastrectomy (LSG) based on a large single-center cohort experience. Methods A retrospective observational study was conducted. Clinical data of patients who underwent LSG at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from June 2021 to June 2024 were collected based on predefined inclusion and exclusion criteria. The outcomes including percentage of total weight loss (%TWL), metabolic disease remission, and the incidence of postoperative complications were assessed. Results A total of 1 568 patients met the inclusion and exclusion criteria were finally included, including 304 males and 1 264 females. The age at surgery was (31.51±8.01）years old, and the body mass index was (37.26±4.18) kg/m². At 1 year after surgery, the %TWL was (32.84±6.38)%, and the complete remission rate of diabetes was 96.2% (304/316). Complications within 1 year after surgery: 1 (0.06%) case of postoperative bleeding, 2 (0.13%) cases of gastric leakage, 1 (0.06%) case of vitamin B1 deficiency, and 1 (0.06%) case of unilateral common peroneal nerve entrapment injury. The total complication rate was 0.32% (5/1 568). No mortality was observed. Conclusions LSG has significant short-term efficacy and higher safety in treatment of obesity and related metabolic diseases. In particular, experiences in aspects such as complication prevention and multidisciplinary follow-up management could provide references for centers in the early stage of development.

1.	国家卫生健康委食品安全标准与监测评估司, 中国疾病预防控制中心营养与健康所, 成人肥胖食养指南编写专家组, 等. 成人肥胖食养指南(2024年版). 卫生研究, 2024, 53(3): 347-351.
2.	中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢外科综合管理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2023年度报告. 中华肥胖与代谢病电子杂志, 2024, 10(2): 73-83.
3.	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). 中国实用外科杂志, 2019, 39(4): 301-306.
4.	朱利勇, 高祥, 李鹏洲, 等. 腹腔镜袖状胃切除术规范化操作要点. 中华消化外科杂志, 2024, 23(8): 1044-1048.
5.	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. 腹腔镜袖状胃切除术操作指南(2018版). 中华肥胖与代谢病电子杂志, 2018, 4(4): 196-201.
6.	骆鹏, 陈国俊, 陈炯煌, 等. 右侧微创三孔法腹腔镜袖状胃切除术治疗肥胖症的应用价值. 中华消化外科杂志, 2022, 21(11): 1461-1466.
7.	《缓解型糖尿病中国专家共识》编写专家委员会. 缓解2型糖尿病中国专家共识. 中国全科医学, 2021, 24(32): 4037-4048.
8.	Yamaguchi T, Tani M, Kasama K, et al. Reference values for weight loss during 1 year after sleeve gastrectomy: a multicenter retrospective study in Japan. Obes Surg, 2022, 32(8): 2672-2681.
9.	Drai C, Chierici A, Schiavo L, et al. Long-term results of sleeve gastrectomy and Roux-en-Y gastric bypass in individuals older than 60 years with morbid obesity. Obes Surg, 2023, 33(12): 3850-3859.
10.	Lee WJ, Almulaifi A, Tsou JJ, et al. Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: predicting the success by ABCD score. Surg Obes Relat Dis, 2015, 11(5): 991-996.
11.	Lin S, Guan W, Yang N, et al. Short-term outcomes of sleeve gastrectomy plus jejunojejunal bypass: a retrospective comparative study with sleeve gastrectomy and Roux-en-Y gastric bypass in Chinese patients with BMI ≥35 kg/m². Obes Surg, 2019, 29(4): 1352-1359.
12.	Tranchart H, Rebibo L, Gaillard M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surg Endosc, 2020, 34(9): 3978-3985.
13.	Wu D, Wang L, Jiang T. Efficacy comparison of laparoscopic sleeve gastrectomy in type 2 diabetes patients with a BMI 30–34.9 kg/m² versus BMI < 30 kg/m². Surg Endosc, 2021, 35(4): 1544-1550.
14.	Sha Y, Huang X, Ke P, et al. Laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Surg, 2020, 30(5): 1660-1670.
15.	梁辉, 管蔚, 林士波, 等. 单中心1 139例减重代谢手术经验总结. 中国实用外科杂志, 2019, 39(4): 343-345.
16.	De Angelis F, Abdelgawad M, Rizzello M, et al. Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence. Surg Endosc, 2017, 31(9): 3547-3551.
17.	Sakran N, Raziel A, Goitein O, et al. Laparoscopic sleeve gastrectomy for morbid obesity in 3 003 patients: results at a high-volume bariatric center. Obes Surg, 2016, 26(9): 2045-2050.
18.	Highet A, Johnson EH, Bonham AJ, et al. Cost-effectiveness of staple line reinforcement in laparoscopic sleeve gastrectomy. Ann Surg, 2023, 277(1): 121-126.
19.	Aboueisha MA, Freeman M, Allotey JK, et al. Battle of the buttress: 5-year propensity-matched analysis of staple-line reinforcement techniques from the MBSAQIP database. Surg Endosc, 2023, 37(4): 3090-3102.
20.	Abu-Ghanem Y, Meydan C, Segev L, et al. Gastric wall thickness and the choice of linear staples in laparoscopic sleeve gastrectomy: challenging conventional concepts. Obes Surg, 2017, 27(3): 837-843.
21.	Kitaghenda FK, Shu C, Wang J, et al. Measurement of gastric wall thickness after laparoscopic sleeve gastrectomy: obesity comorbidities and gastric wall in Chinese patients with obesity. Updates Surg, 2023, 75(5): 1235-1242.
22.	Barski K, Binda A, Kudlicka E, et al. Gastric wall thickness and stapling in laparoscopic sleeve gastrectomy—a literature review. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 122-127.
23.	Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12 000 cases. Surg Obes Relat Dis, 2012, 8(1): 8-19.
24.	Choi YY, Bae J, Hur KY, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg, 2012, 22(8): 1206-1213.
25.	Wang Z, Dai X, Xie H, et al. The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: a meta-analysis of randomized controlled trials. Int J Surg, 2016, 25: 145-152.
26.	Berger ER, Clements RH, Morton JM, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Ann Surg, 2016, 264(3): 464-473.
27.	Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg, 2015, 25(7): 1133-1141.
28.	Jing W, Huang Y, Feng J, et al. The clinical effectiveness of staple line reinforcement with different matrix used in surgery. Front Bioeng Biotechnol, 2023, 11: 1178619. doi: 10.3389/fbioe.2023.1178619.
29.	Di Lorenzo N, Antoniou SA, Batterham RL, et al. Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg Endosc, 2020, 34(6): 2332-2358.
30.	Karaman K, Aziret M, Ercan M, et al. A preventive strategy for staple line bleeding in morbidly obese patients undergoing sleeve gastrectomy. J Laparoendosc Adv Surg Tech A, 2017, 27(10): 1015-1021.
31.	Janik MR, Walędziak M, Brągoszewski J, et al. Prediction model for hemorrhagic complications after laparoscopic sleeve gastrectomy: development of SLEEVE BLEED calculator. Obes Surg, 2017, 27(4): 968-972.
32.	Albanopoulos K, Alevizos L, Linardoutsos D, et al. Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients. Obes Surg, 2011, 21(6): 687-691.
33.	Doumouras AG, Maeda A, Jackson TD. The role of routine abdominal drainage after bariatric surgery: a metabolic and bariatric surgery accreditation and quality improvement program study. Surg Obes Relat Dis, 2017, 13(12): 1997-2003.
34.	Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4 888 patients. Surg Endosc, 2012, 26(6): 1509-1515.
35.	Stroh C, Köckerling F, Volker L, et al. Results of more than 11 800 sleeve gastrectomies: data analysis of the German bariatric surgery registry. Ann Surg, 2016, 263(5): 949-955.
36.	Husain F, Jeong IH, Spight D, et al. Risk factors for early postoperative complications after bariatric surgery. Ann Surg Treat Res, 2018, 95(2): 100-110.
37.	Chang PC, Chen KH, Jhou HJ, et al. Promising effects of 33 to 36 Fr. bougie calibration for laparoscopic sleeve gastrectomy: a systematic review and network meta-analysis. Sci Rep, 2021, 11(1): 15217. doi: 10.1038/s41598-021-94716-1.
38.	Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9 991 cases. Ann Surg, 2013, 257(2): 231-237.
39.	Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc, 2020, 34(1): 396-407.
40.	Chen YS, Loh EW, Shen SC, et al. Efficacy of fibrin sealant in reducing complication risk after bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2021, 31(3): 1158-1167.
41.	Yolsuriyanwong K, Ingviya T, Kongkamol C, et al. Effects of intraoperative leak testing on postoperative leak-related outcomes after primary bariatric surgery: an analysis of the MBSAQIP database. Surg Obes Relat Dis, 2019, 15(9): 1530-1540.
42.	Jung JJ, Jackson T, Gordon L, et al. Intraoperative leak test is associated with lower postoperative bleed rate in primary sleeve gastrectomy: a propensity matched analysis of primary and revision bariatric surgery using the MBSAQIP database. Surg Endosc, 2022, 36(1): 753-763.
43.	Chivot C, Rebibo L, Robert B, et al. Value of routine upper gastrointestinal swallow study after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis, 2017, 13(5): 758-765.
44.	Vitello DJ, Vitello JM, Beach-Bachmann J, et al. Value of routine gastrografin upper gastrointestinal study after sleeve gastrectomy. JAMA Surg, 2019, 154(2): 181-182.
45.	Sethi M, Magrath M, Somoza E, et al. The utility of radiological upper gastrointestinal series and clinical indicators in detecting leaks after laparoscopic sleeve gastrectomy: a case-controlled study. Surg Endosc, 2016, 30(6): 2266-2275.
46.	de Moura DTH, Hirsch BS, Boghossian MB, et al. Low-cost modified endoscopic vacuum therapy using a triple-lumen tube allows nutrition and drainage for treatment of an early post-bariatric surgery leak. Endoscopy, 2022, 54(7): E376-E377. doi: 10.1055/a-1540-5870.
47.	Intriago JMV, de Moura DTH, do Monte Junior ES, et al. Endoscopic vacuum therapy (EVT) for the treatment of post-bariatric surgery leaks and fistulas: a systematic review and meta-analysis. Obes Surg, 2022, 32(10): 3435-3451.
48.	Shoar S, Poliakin L, Khorgami Z, et al. Efficacy and safety of the over-the-scope clip (OTSC) system in the management of leak and fistula after laparoscopic sleeve gastrectomy: a systematic review. Obes Surg, 2017, 27(9): 2410-2418.
49.	Rogalski P, Swidnicka-Siergiejko A, Wasielica-Berger J, et al. Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis. Surg Endosc, 2021, 35(3): 1067-1087.
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1. 国家卫生健康委食品安全标准与监测评估司, 中国疾病预防控制中心营养与健康所, 成人肥胖食养指南编写专家组, 等. 成人肥胖食养指南(2024年版). 卫生研究, 2024, 53(3): 347-351.
2. 中国医师协会外科医师分会肥胖和代谢病外科专家工作组, 中国医师协会外科医师分会肥胖代谢外科综合管理专家工作组, 中国肥胖代谢外科研究协作组. 中国肥胖代谢外科数据库: 2023年度报告. 中华肥胖与代谢病电子杂志, 2024, 10(2): 73-83.
3. 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). 中国实用外科杂志, 2019, 39(4): 301-306.
4. 朱利勇, 高祥, 李鹏洲, 等. 腹腔镜袖状胃切除术规范化操作要点. 中华消化外科杂志, 2024, 23(8): 1044-1048.
5. 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. 腹腔镜袖状胃切除术操作指南(2018版). 中华肥胖与代谢病电子杂志, 2018, 4(4): 196-201.
6. 骆鹏, 陈国俊, 陈炯煌, 等. 右侧微创三孔法腹腔镜袖状胃切除术治疗肥胖症的应用价值. 中华消化外科杂志, 2022, 21(11): 1461-1466.
7. 《缓解型糖尿病中国专家共识》编写专家委员会. 缓解2型糖尿病中国专家共识. 中国全科医学, 2021, 24(32): 4037-4048.
8. Yamaguchi T, Tani M, Kasama K, et al. Reference values for weight loss during 1 year after sleeve gastrectomy: a multicenter retrospective study in Japan. Obes Surg, 2022, 32(8): 2672-2681.
9. Drai C, Chierici A, Schiavo L, et al. Long-term results of sleeve gastrectomy and Roux-en-Y gastric bypass in individuals older than 60 years with morbid obesity. Obes Surg, 2023, 33(12): 3850-3859.
10. Lee WJ, Almulaifi A, Tsou JJ, et al. Laparoscopic sleeve gastrectomy for type 2 diabetes mellitus: predicting the success by ABCD score. Surg Obes Relat Dis, 2015, 11(5): 991-996.
11. Lin S, Guan W, Yang N, et al. Short-term outcomes of sleeve gastrectomy plus jejunojejunal bypass: a retrospective comparative study with sleeve gastrectomy and Roux-en-Y gastric bypass in Chinese patients with BMI ≥35 kg/m². Obes Surg, 2019, 29(4): 1352-1359.
12. Tranchart H, Rebibo L, Gaillard M, et al. Short-term outcomes of single-port versus conventional laparoscopic sleeve gastrectomy: a propensity score matched analysis. Surg Endosc, 2020, 34(9): 3978-3985.
13. Wu D, Wang L, Jiang T. Efficacy comparison of laparoscopic sleeve gastrectomy in type 2 diabetes patients with a BMI 30–34.9 kg/m² versus BMI < 30 kg/m². Surg Endosc, 2021, 35(4): 1544-1550.
14. Sha Y, Huang X, Ke P, et al. Laparoscopic Roux-en-Y gastric bypass versus sleeve gastrectomy for type 2 diabetes mellitus in nonseverely obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Surg, 2020, 30(5): 1660-1670.
15. 梁辉, 管蔚, 林士波, 等. 单中心1 139例减重代谢手术经验总结. 中国实用外科杂志, 2019, 39(4): 343-345.
16. De Angelis F, Abdelgawad M, Rizzello M, et al. Perioperative hemorrhagic complications after laparoscopic sleeve gastrectomy: four-year experience of a bariatric center of excellence. Surg Endosc, 2017, 31(9): 3547-3551.
17. Sakran N, Raziel A, Goitein O, et al. Laparoscopic sleeve gastrectomy for morbid obesity in 3 003 patients: results at a high-volume bariatric center. Obes Surg, 2016, 26(9): 2045-2050.
18. Highet A, Johnson EH, Bonham AJ, et al. Cost-effectiveness of staple line reinforcement in laparoscopic sleeve gastrectomy. Ann Surg, 2023, 277(1): 121-126.
19. Aboueisha MA, Freeman M, Allotey JK, et al. Battle of the buttress: 5-year propensity-matched analysis of staple-line reinforcement techniques from the MBSAQIP database. Surg Endosc, 2023, 37(4): 3090-3102.
20. Abu-Ghanem Y, Meydan C, Segev L, et al. Gastric wall thickness and the choice of linear staples in laparoscopic sleeve gastrectomy: challenging conventional concepts. Obes Surg, 2017, 27(3): 837-843.
21. Kitaghenda FK, Shu C, Wang J, et al. Measurement of gastric wall thickness after laparoscopic sleeve gastrectomy: obesity comorbidities and gastric wall in Chinese patients with obesity. Updates Surg, 2023, 75(5): 1235-1242.
22. Barski K, Binda A, Kudlicka E, et al. Gastric wall thickness and stapling in laparoscopic sleeve gastrectomy—a literature review. Wideochir Inne Tech Maloinwazyjne, 2018, 13(1): 122-127.
23. Rosenthal RJ, International Sleeve Gastrectomy Expert Panel, Diaz AA, et al. International sleeve gastrectomy expert panel consensus statement: best practice guidelines based on experience of >12 000 cases. Surg Obes Relat Dis, 2012, 8(1): 8-19.
24. Choi YY, Bae J, Hur KY, et al. Reinforcing the staple line during laparoscopic sleeve gastrectomy: does it have advantages? A meta-analysis. Obes Surg, 2012, 22(8): 1206-1213.
25. Wang Z, Dai X, Xie H, et al. The efficacy of staple line reinforcement during laparoscopic sleeve gastrectomy: a meta-analysis of randomized controlled trials. Int J Surg, 2016, 25: 145-152.
26. Berger ER, Clements RH, Morton JM, et al. The impact of different surgical techniques on outcomes in laparoscopic sleeve gastrectomies: the first report from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). Ann Surg, 2016, 264(3): 464-473.
27. Shikora SA, Mahoney CB. Clinical benefit of gastric staple line reinforcement (SLR) in gastrointestinal surgery: a meta-analysis. Obes Surg, 2015, 25(7): 1133-1141.
28. Jing W, Huang Y, Feng J, et al. The clinical effectiveness of staple line reinforcement with different matrix used in surgery. Front Bioeng Biotechnol, 2023, 11: 1178619. doi: 10.3389/fbioe.2023.1178619.
29. Di Lorenzo N, Antoniou SA, Batterham RL, et al. Clinical practice guidelines of the European Association for Endoscopic Surgery (EAES) on bariatric surgery: update 2020 endorsed by IFSO-EC, EASO and ESPCOP. Surg Endosc, 2020, 34(6): 2332-2358.
30. Karaman K, Aziret M, Ercan M, et al. A preventive strategy for staple line bleeding in morbidly obese patients undergoing sleeve gastrectomy. J Laparoendosc Adv Surg Tech A, 2017, 27(10): 1015-1021.
31. Janik MR, Walędziak M, Brągoszewski J, et al. Prediction model for hemorrhagic complications after laparoscopic sleeve gastrectomy: development of SLEEVE BLEED calculator. Obes Surg, 2017, 27(4): 968-972.
32. Albanopoulos K, Alevizos L, Linardoutsos D, et al. Routine abdominal drains after laparoscopic sleeve gastrectomy: a retrospective review of 353 patients. Obes Surg, 2011, 21(6): 687-691.
33. Doumouras AG, Maeda A, Jackson TD. The role of routine abdominal drainage after bariatric surgery: a metabolic and bariatric surgery accreditation and quality improvement program study. Surg Obes Relat Dis, 2017, 13(12): 1997-2003.
34. Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4 888 patients. Surg Endosc, 2012, 26(6): 1509-1515.
35. Stroh C, Köckerling F, Volker L, et al. Results of more than 11 800 sleeve gastrectomies: data analysis of the German bariatric surgery registry. Ann Surg, 2016, 263(5): 949-955.
36. Husain F, Jeong IH, Spight D, et al. Risk factors for early postoperative complications after bariatric surgery. Ann Surg Treat Res, 2018, 95(2): 100-110.
37. Chang PC, Chen KH, Jhou HJ, et al. Promising effects of 33 to 36 Fr. bougie calibration for laparoscopic sleeve gastrectomy: a systematic review and network meta-analysis. Sci Rep, 2021, 11(1): 15217. doi: 10.1038/s41598-021-94716-1.
38. Parikh M, Issa R, McCrillis A, et al. Surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy: a systematic review and meta-analysis of 9 991 cases. Ann Surg, 2013, 257(2): 231-237.
39. Gagner M, Kemmeter P. Comparison of laparoscopic sleeve gastrectomy leak rates in five staple-line reinforcement options: a systematic review. Surg Endosc, 2020, 34(1): 396-407.
40. Chen YS, Loh EW, Shen SC, et al. Efficacy of fibrin sealant in reducing complication risk after bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2021, 31(3): 1158-1167.
41. Yolsuriyanwong K, Ingviya T, Kongkamol C, et al. Effects of intraoperative leak testing on postoperative leak-related outcomes after primary bariatric surgery: an analysis of the MBSAQIP database. Surg Obes Relat Dis, 2019, 15(9): 1530-1540.
42. Jung JJ, Jackson T, Gordon L, et al. Intraoperative leak test is associated with lower postoperative bleed rate in primary sleeve gastrectomy: a propensity matched analysis of primary and revision bariatric surgery using the MBSAQIP database. Surg Endosc, 2022, 36(1): 753-763.
43. Chivot C, Rebibo L, Robert B, et al. Value of routine upper gastrointestinal swallow study after laparoscopic sleeve gastrectomy. Surg Obes Relat Dis, 2017, 13(5): 758-765.
44. Vitello DJ, Vitello JM, Beach-Bachmann J, et al. Value of routine gastrografin upper gastrointestinal study after sleeve gastrectomy. JAMA Surg, 2019, 154(2): 181-182.
45. Sethi M, Magrath M, Somoza E, et al. The utility of radiological upper gastrointestinal series and clinical indicators in detecting leaks after laparoscopic sleeve gastrectomy: a case-controlled study. Surg Endosc, 2016, 30(6): 2266-2275.
46. de Moura DTH, Hirsch BS, Boghossian MB, et al. Low-cost modified endoscopic vacuum therapy using a triple-lumen tube allows nutrition and drainage for treatment of an early post-bariatric surgery leak. Endoscopy, 2022, 54(7): E376-E377. doi: 10.1055/a-1540-5870.
47. Intriago JMV, de Moura DTH, do Monte Junior ES, et al. Endoscopic vacuum therapy (EVT) for the treatment of post-bariatric surgery leaks and fistulas: a systematic review and meta-analysis. Obes Surg, 2022, 32(10): 3435-3451.
48. Shoar S, Poliakin L, Khorgami Z, et al. Efficacy and safety of the over-the-scope clip (OTSC) system in the management of leak and fistula after laparoscopic sleeve gastrectomy: a systematic review. Obes Surg, 2017, 27(9): 2410-2418.
49. Rogalski P, Swidnicka-Siergiejko A, Wasielica-Berger J, et al. Endoscopic management of leaks and fistulas after bariatric surgery: a systematic review and meta-analysis. Surg Endosc, 2021, 35(3): 1067-1087.
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