Nguyen Ninh T, Rivers Ryan, Wolfe Bruce M
Department of Surgery, University of California, Irvine, Medical Center, Orange, CA 92868-3298, USA.
Obes Surg. 2003 Feb;13(1):62-5. doi: 10.1381/096089203321136601.
Early gastrointestinal (GI) hemorrhage after open gastric bypass has been infrequently reported. The aim of this study was to examine the incidence of early GI hemorrhage after laparoscopic Roux-en-Y gastric bypass (LRYGBP), its presentation, and possible treatment options.
A retrospective review of 5 patients who developed early postoperative GI hemorrhage after LRYGBP was performed. The charts were reviewed for demographics, clinical presentation, diagnostic evaluation, and treatment. All patients underwent a transected LRYGBP with creation of the gastrojejunostomy anastomosis with a circular stapler and the jejunojejunostomy anastomosis with a linear stapler.
Of the 155 patients in our database who underwent LRYGBP, 5 (3.2%) developed early clinical GI hemorrhage. There were 2 males with an average age of 40 years. Clinical presentations of GI hemorrhage were hematemesis (2 patients), bright red blood per rectum (1 patient), melena (1 patient), and hypotension (1 patient). A diagnostic study (nuclear scintigraphy) was performed in only 1 of 5 patients. 3 of 5 patients were managed nonoperatively; 2 patients required fluid and blood resuscitation, and the other patient was managed without blood transfusion. The onset of hemorrhage in these 3 patients occurred 24 hours postoperatively or later. 2 of 5 patients required operative intervention for control of hemorrhage. The onset of hemorrhage or hypotension in these 2 patients occurred within 12 hours after surgery. The sites of hemorrhage were at the gastric remnant staple-lines in 1 patient and at the gastrojejunostomy and gastric remnant staple-lines in the other patient.
Early GI hemorrhage is a potential complication after transected LRYGBP. Early reoperative intervention should be performed for patients with hemodynamic instability and patients with early onset of hemorrhage after surgery.
开放性胃旁路术后早期胃肠道（GI）出血鲜有报道。本研究旨在探讨腹腔镜Roux-en-Y胃旁路术（LRYGBP）后早期GI出血的发生率、表现形式及可能的治疗选择。
对5例LRYGBP术后发生早期GI出血的患者进行回顾性研究。查阅病历以了解人口统计学资料、临床表现、诊断评估及治疗情况。所有患者均接受了横断式LRYGBP，使用圆形吻合器进行胃空肠吻合，使用线性吻合器进行空肠空肠吻合。
在我们数据库中接受LRYGBP的155例患者中，5例（3.2%）发生了早期临床GI出血。其中男性2例，平均年龄40岁。GI出血的临床表现为呕血（2例）、直肠鲜血便（1例）、黑便（1例）及低血压（1例）。5例患者中仅1例进行了诊断性检查（核素显像）。5例患者中有3例采取非手术治疗；2例患者需要液体和血液复苏，另1例患者未输血进行治疗。这3例患者的出血发生在术后24小时或更晚。5例患者中有2例需要手术干预以控制出血。这2例患者的出血或低血压发生在术后12小时内。出血部位1例位于胃残端吻合钉线处，另1例位于胃空肠吻合口及胃残端吻合钉线处。
横断式LRYGBP术后早期GI出血是一种潜在并发症。对于血流动力学不稳定及术后早期出血的患者应尽早进行再次手术干预。
