Angrisani Luigi, Lorenzo Michele, Borrelli Vincenzo, Ciannella Monica, Bassi Uberto Andrea, Scarano Paolo
ASL NA1-Laparoscopic and Minimally Invasive Surgical Unit, S. Giovanni Bosco Hospital and Federico II University, Piazza Vittoria 7, 80121 Naples, Italy.
Obes Surg. 2004 Oct;14(9):1198-202. doi: 10.1381/0960892042387075.
A prospective comparison was conducted of extraluminal bleeding following gastric transection with or without staple-line reinforcement by dehydrated bovine pericardium (Peri-Strips Dry--PSD) during laparoscopic Roux-en-Y gastric bypass (LRYGBP).
From January 2001 to September 2003, 98 consecutive morbidly obese patients underwent LRYGBP. Patients were randomly allocated to 2 groups according to the use (Group A, n= 50) or not (Group B, n= 48) of Peri-Strips Dry. In both groups, mortality, intra- and postoperative early and late complications, operating-time, number of hemostatic clips used, blood transfusion and any specific event directly related to the prosthetic material were prospectively evaluated. Data were expressed as mean +/- SD except as otherwise indicated. Statistical analysis was done by means of Student t-test and Fisher exact test. P-value cut off for statistical significance was set at 0.05.
Intra- and postoperative mortality were absent. Intra-operative methylene blue test was positive in 6/48 (12.5%) of Group B patients (P<0.001). Overall laparotomic conversion was 3/98 patients (3.1%). One/48 Group B patient was converted because of unsatisfactory exposure and one for linear stapler misfire. One/50 Group A patients was converted for short gastric vessels bleeding during dissection. No patients were re-operated or transfused because of extraluminal bleeding. Mean number of clips used was significantly lower in Group A patients (5 vs 23, P<0.001). The operating-time was significantly less in Group A patients (120+/-60 vs 220+/-100 minutes, P<0.01).
Gastric staple-lines reinforced with Peri-Strips Dry result in a significant reduction in the number of Endo-clips used and prevent bleeding. A dry operating field was obtained, and operating-time was significantly reduced. No adverse events could be related to the use PSD.
在腹腔镜Roux-en-Y胃旁路术（LRYGBP）期间，对采用或不采用脱水牛心包（Peri-Strips Dry--PSD）进行吻合口加固的胃切断术后腔外出血情况进行了前瞻性比较。
2001年1月至2003年9月，98例连续的病态肥胖患者接受了LRYGBP手术。根据是否使用Peri-Strips Dry将患者随机分为两组（A组，n = 50；B组，n = 48）。前瞻性评估两组患者的死亡率、术中和术后早期及晚期并发症、手术时间、使用的止血夹数量、输血情况以及与假体材料直接相关的任何特定事件。数据以均值±标准差表示，除非另有说明。采用学生t检验和Fisher精确检验进行统计分析。设定具有统计学意义的P值临界值为0.05。
术中和术后均无死亡病例。B组6/48例（12.5%）患者术中亚甲蓝试验呈阳性（P<0.001）。总体剖腹手术转化率为3/98例患者（3.1%）。B组1/48例患者因暴露不满意而中转手术，1例因直线缝合器误发射而中转手术。A组1/50例患者因解剖过程中胃短血管出血而中转手术。没有患者因腔外出血而再次手术或输血。A组患者使用的夹子平均数量显著较少（5个对23个，P<0.001）。A组患者的手术时间显著更短（120±60分钟对220±100分钟，P<0.01）。
用Peri-Strips Dry加固胃吻合口可显著减少Endo夹的使用数量并预防出血。获得了无血的手术视野，手术时间显著缩短。未发现与使用PSD相关的不良事件。
