Sundbom M, Gustavsson S
Department of Surgery, University Hospital, 751 85 Uppsala, Sweden.
Br J Surg. 2004 Apr;91(4):418-23. doi: 10.1002/bjs.4505.
: Roux-en-Y gastric bypass (RYGBP) has increased in popularity since the introduction of the laparoscopic procedure, but this approach requires extensive surgical skill and the learning curve is steep. The present study examined the suitability of hand-assisted laparoscopy for RYGBP.
In a prospective trial, 50 patients (median age 38 years, body mass index 45 kg/m(2)) were randomized to either hand-assisted (n = 25) or open (n = 25) RYGBP. The hand-assisted device was introduced through a right subcostal incision. Laparoscopic staplers were also used in the open group, allowing a short upper midline incision. The gastrojejunostomy was made by means of a circular stapler and the Roux limb placed behind the colon and excluded stomach.
The postoperative outcome, with respect to morphine consumption, complications, hospital stay (6 days) and weight loss, was similar in the two groups. The operating time was significantly longer in the hand-assisted group (150 versus 85 min; P < 0.001) but there was no conversion to open operation. One patient in the hand-assisted group was reoperated owing to leakage and one patient developed an incisional hernia after open RYGBP.
The hand-assisted technique was feasible and allowed good working conditions in all patients. However, the postoperative outcome was excellent in both groups and there was no advantage to the hand-assisted technique.
自腹腔镜手术引入以来，Roux-en-Y胃旁路术（RYGBP）越来越受欢迎，但这种方法需要广泛的手术技能，且学习曲线较陡。本研究探讨了手辅助腹腔镜在RYGBP中的适用性。
在一项前瞻性试验中，50例患者（中位年龄38岁，体重指数45kg/m²）被随机分为手辅助组（n = 25）或开放组（n = 25）接受RYGBP。通过右肋下切口引入手辅助装置。开放组也使用腹腔镜吻合器，允许在上腹部中线做一个短切口。胃空肠吻合术采用圆形吻合器进行，Roux袢置于结肠后方并排除胃。
两组在吗啡用量、并发症、住院时间（6天）和体重减轻方面的术后结果相似。手辅助组的手术时间明显更长（150分钟对85分钟；P < 0.001），但没有转为开放手术。手辅助组有1例患者因渗漏再次手术，开放组有1例患者在RYGBP术后发生切口疝。
手辅助技术是可行的，并且在所有患者中都能提供良好的手术条件。然而，两组的术后结果都很好，手辅助技术没有优势。
