Kini S, Gagner M, de Csepel J, Gentileschi P, Dakin G
Division of Laparoscopic Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
Obes Surg. 2001 Aug;11(4):469-73. doi: 10.1381/096089201321209350.
A Silastic ring has been used to prevent dilation of the gastrojejunostomy in Roux-en-Y gastric bypass (RYGBP). The use of a bio-membrane may prevent dilation of the anastomosis without the risks associated with prostheses. The aim of this study was to evaluate the feasibility and safety of applying such a bio-membrane around the gastrojejunostomy in Laparoscopic RYGBP (LRYGBP).
We used a new bio-membrane, that is derived from porcine small intestinal submucosa (SIS) and acts as a scaffolding for the ingrowth of connective tissue. Over a 4-month period, 14 LRYGBP patients had their proximal anastomosis wrapped with 10 x 2.5 cm SIS by a single surgeon. We compared these patients to a control group of LRYGBP patients matched for BMI.
The average age of the patients was 35.0 years (control group: 45.1 years). The patients had a mean initial BMI of 44.7 kg/m2 (+/- 5.9) standard error, and the control subjects had a mean initial BMI of 46.7 kg/m2 (+/- 6.5). SIS application took a mean time of 11 (+/- 3) minutes without any intraoperative complication. The median hospital stay was 3.5 days in the experimental group and 3.7 days in controls. Three patients developed a symptomatic stenosis at the gastrojejunostomy following surgery. In the control group there were two stenoses. At an average follow-up of 87 days (controls: 95 days), the mean reduction in BMI was 7.8 (+/- 0.8) kg/m2 [controls 8.6 kg/m2 (+/- 1.5)].
Application of SIS around the gastrojejunostomy in patients undergoing LRYGBP is feasible and safe. Further follow-up is required, however, to evaluate the effectiveness in preventing dilation of the anastomosis.
硅橡胶环已被用于预防Roux-en-Y胃旁路术（RYGBP）中胃空肠吻合口的扩张。使用生物膜可能在不产生与假体相关风险的情况下预防吻合口扩张。本研究的目的是评估在腹腔镜RYGBP（LRYGBP）中，在胃空肠吻合口周围应用这种生物膜的可行性和安全性。
我们使用了一种新的生物膜，其来源于猪小肠黏膜下层（SIS），并作为结缔组织向内生长的支架。在4个月的时间里，14例LRYGBP患者由一名外科医生用10×2.5 cm的SIS包裹其近端吻合口。我们将这些患者与根据BMI匹配的LRYGBP患者对照组进行比较。
患者的平均年龄为35.0岁（对照组：45.1岁）。患者的初始平均BMI为44.7 kg/m2（±5.9）标准误，对照组的初始平均BMI为46.7 kg/m2（±6.5）。应用SIS的平均时间为11（±3）分钟，无任何术中并发症。实验组的中位住院时间为3.5天，对照组为3.7天。3例患者术后在胃空肠吻合口出现有症状的狭窄。对照组有2例狭窄。平均随访87天（对照组：95天）时，BMI的平均降低值为7.8（±0.8）kg/m2[对照组为8.6 kg/m2（±1.5）]。
在接受LRYGBP的患者中，在胃空肠吻合口周围应用SIS是可行且安全的。然而，需要进一步随访以评估预防吻合口扩张的有效性。
