腹腔鏡下スリーブ状胃切除術後の狭窄に対し腹腔鏡下胃バイパス術を施行した1例

Laparoscopic gastric bypass for stenosis after laparoscopic sleeve gastrectomy : a case report

◆要旨：患者は40歳，女性．BMIは37.1kg/m²で，糖尿病，高血圧，脂質代謝異常，脂肪肝を合併していた．肥満症に対し腹腔鏡下スリーブ状胃切除術を施行した．胃切離3回目の自動縫合器がステープリング不良となり，その内側で再縫合した．術中内視鏡検査では狭窄は認めなかった．液体摂取は可能であり，術後9日目に退院した．退院後より頻回の嘔吐を認め，固形物の摂取は不可能だった．内視鏡検査にて再縫合部が捻れのため狭窄しており，内視鏡的バルーン拡張術では改善しなかった．術後4か月目に腹腔鏡下胃バイパス術を施行した．術後の経過は良好で，肥満関連合併症はすべて治癒した．腹腔鏡下スリーブ状胃切除術では約1％に狭窄の合併症が報告されている．本例ではrevision surgeryが有効であった．

A 40-year old woman with diabetes mellitus, hypertension, hyperlipidemia, and fatty liver, underwent laparoscopic sleeve gastrectomy for morbid obesity （BMI 37.1kg/m²）. The third firing of the linear stapler（Endo GIA^TM Duet TRS^TM） failed, necessitating re-stapling at the inner side of the failed staple line. Intraoperative endoscopy showed no abnormalities. After discharge, she was unable to tolerate solid food. Stenosis caused by twisting of the stomach at the site of re-stapling was seen on upper-GI imaging and endoscopy. Endoscopic balloon dilation did not relieve the stenosis, and laparoscopic gastric bypass was performed. The postoperative course after surgical revision was uneventful, resulting in weight loss and cure of comorbidities. Gastric stenosis after laparoscopic sleeve gastrectomy has been reported in about 1％ of patients. We report successful treatment of a patient with gastric twisting and stenosis after sleeve gastrectomy by laparoscopic gastric bypass.