Champion J Ken, Williams Michael
Videoscopic Institute of Atlanta, Atlanta, GA, USA.
Obes Surg. 2003 Aug;13(4):596-600. doi: 10.1381/096089203322190808.
Small bowel obstruction (SBO) is a recognized complication of open bariatric surgery; however, the incidence after laparoscopic procedures is not clearly established. This paper reviews our experience with small bowel obstruction after laparoscopic Roux-en-Y gastric bypass.
Between 1995 and 2001, 711 (246 antecolic, 465 retrocolic) patients underwent a laparoscopic proximal divided Roux-en-Y gastric bypass via the linear endostapler technique. 13 patients (1.8%) developed SBO requiring surgical intervention. There were 11 females and 2 males, ages 29-60 (mean 38), with mean weight 126 kg (range 105-188), and mean BMI 50 (range 41-59). 7 obstructive patients (55%) had undergone previous open abdominal surgery. Median time to obstruction was 21 days (range 5-1095). Mean follow-up of all patients is 43 months (range 3-79).
Etiology of obstruction was internal hernia - 6, adhesive bands - 5 (only 2 were related to prior open surgery), mesocolon window scarring - 1, and incarcerated ventral hernia - 1. The incidence of SBO was 4.5% (11/246) in the retrocolic group, and 0.43% (2/465) in the antecolic group, which was highly significant (P=.006). 1 adhesive patient required an open bowel resection for ischemia. There was 1 death.
SBO occurred with an overall incidence of 1.8% in a large series of laparoscopic gastric bypass patients, and was associated with a high morbidity. A significant decrease in occurrence was found after adoption of antecolic placement of the Roux limb.
小肠梗阻（SBO）是开腹减肥手术公认的并发症；然而，腹腔镜手术后的发病率尚未明确。本文回顾了我们在腹腔镜Roux-en-Y胃旁路术后小肠梗阻方面的经验。
1995年至2001年间，711例患者（246例结肠前，465例结肠后）通过线性切割吻合器技术接受了腹腔镜近端 Roux-en-Y胃旁路手术。13例患者（1.8%）发生SBO需要手术干预。其中女性11例，男性2例，年龄29 - 60岁（平均38岁），平均体重126 kg（范围105 - 188 kg），平均BMI为50（范围41 - 59）。7例梗阻患者（55%）曾接受过开腹手术。梗阻发生的中位时间为21天（范围5 - 1095天）。所有患者的平均随访时间为43个月（范围3 - 79个月）。
梗阻病因包括内疝6例、粘连带5例（仅2例与既往开腹手术有关）、结肠系膜窗瘢痕形成1例、嵌顿性腹疝1例。结肠后组SBO发生率为4.5%（11/246），结肠前组为0.43%（2/465），差异有高度统计学意义（P = 0.006）。1例粘连患者因肠缺血需要行开腹肠切除术。有1例死亡。
在一大系列腹腔镜胃旁路手术患者中，SBO的总体发生率为1.8%，且发病率较高。采用结肠前Roux袢放置后，其发生率显著降低。
