Cagigas J C, Martino E, Escalante C F, Ingelmo A, Estefanía R, Gutierrez J M, Fleitas M G
Hospital Valdecilla, University of Cantabria, Santander, Spain.
Obes Surg. 1999 Apr;9(2):166-70. doi: 10.1381/096089299765553421.
Laparoscopic gastric bypass and vertical banded gastroplasty are two procedures used in the treatment of morbid obesity. The authors describe alternative techniques of laparoscopic distal gastric bypass as a modification of the Scopinaro procedure, which were used experimentally in a porcine model.
Five pigs were used. The laparoscopic procedure was performed with the pigs under general anesthesia after pneumoperitoneum had been achieved. Five or six trocars were used. One port was converted from 12 to 33 mm, and all the other ports were 10-11 mm. The initial surgical technique was similar to that used by others for laparoscopic gastrectomy, except that atraumatic ultracision was used for all the dissection. The stomach was stapled with a linear cutter stapler (Endopath, 31 mm) to create a 50-ml pouch. The ileum was divided with a linear cutter-stapler (Endopath, 31 mm) or ultracision cautery. A long length of ileum was positioned between the stomach pouch and the jejunoileostomy. Only 50-70 cm of terminal ileum was preserved as a common channel. In three animals, the circular stapler (ILS, 21 mm) was used to produce an end-to-side anastomosis. In one animal, two purse-string sutures were handsewn in the ileum and jejunum stumps, and in another two animals, two endoloops were used for the anvil. In two animals, the linear stapler was used to form a side-to-side pouch stomach-ileum and jejunoileostomy anastomosis. In other animals, the two types of anastomosis have been combined. All animals were killed after surgery so that the anastomoses could be evaluated for size and integrity.
In all animals, with the circular and linear stapler, both 21 and 13-15 mm anastomoses were intact.
Distal gastric bypass is feasible laparoscopically, with intact anastomoses.
腹腔镜胃旁路术和垂直束带胃成形术是用于治疗病态肥胖的两种手术。作者描述了腹腔镜远端胃旁路术的替代技术，作为斯科皮纳罗手术的一种改良，该技术在猪模型中进行了实验应用。
使用5头猪。在建立气腹后，对处于全身麻醉状态的猪进行腹腔镜手术。使用了5或6个套管针。一个端口从12毫米转换为33毫米，其他所有端口为10 - 11毫米。初始手术技术与其他人用于腹腔镜胃切除术的技术相似，只是所有解剖操作均使用无创伤超声刀。用直线切割缝合器（Endopath，31毫米）缝合胃以创建一个50毫升的胃囊。用直线切割缝合器（Endopath，31毫米）或超声刀烧灼器离断回肠。在胃囊和空肠回肠吻合口之间放置一段较长的回肠。仅保留50 - 70厘米的终末回肠作为共同通道。在3只动物中，使用圆形吻合器（ILS，21毫米）进行端侧吻合。在1只动物中，在回肠和空肠残端手工缝合了两根荷包缝合线，在另外2只动物中，使用两个内圈套器放置吻合器砧座。在2只动物中，使用直线缝合器形成侧侧胃囊 - 回肠和空肠回肠吻合口。在其他动物中，将两种吻合方式进行了组合。所有动物在手术后处死，以便评估吻合口的大小和完整性。
在所有动物中，使用圆形和直线吻合器，21毫米以及13 - 15毫米的吻合口均完整。
腹腔镜下远端胃旁路术是可行的，吻合口完整。
