Chousleb Elias, Szomstein Samuel, Podkameni David, Soto Flavia, Lomenzo Emanuele, Higa Guillermo, Kennedy Colleen, Villares Alexander, Arias Fernando, Antozzi Priscila, Zundel Natan, Rosenthal Raul
Division of Minimally Invasive Surgery, and The Bariatric Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA.
Obes Surg. 2004 Oct;14(9):1203-7. doi: 10.1381/0960892042387101.
The authors reviewed the benefits of routine placement of closed drains in the peritoneal cavity following laparoscopic Roux-en-Y gastric bypass (LRYGBP). The purpose of the study was to determine whether routine closed abdominal drainage provides diagnostic and therapeutic advantages in the presence of complications such as bleeding and leaks.
The medical records of 593 consecutive patients who had undergone LRYGBP from July 2001 through May 2003 were retrospectively reviewed. In all cases, antecolic antegastric LRYGBP was performed. Two 19-Fr Blake closed suction drains were left in place, one at the gastrojejunostomy and the other at the jejunojejunostomy. The incidence of bleeding and leaks was reviewed, and the utility of the drains relative to diagnosis and management was evaluated.
Bleeding presented in 24 patients (4.4%); in 8, the diagnosis was based on increased sanguinous output from the drain and decreased hematocrit. None of the patients with intraabdominal bleeding required reoperation. Of the 10 patients (1.68%) who presented with leaks, the diagnosis was made within 48 hours postoperatively in 5 patients (50%), based on the characteristics of the drain output. Nonoperative management with drainage and total parenteral nutrition was accomplished in 5 (50%) of the 10 patients with leaks. There was no mortality in the series.
The routine use of abdominal drains after LRYGBP appears to be beneficial. Drains allowed early diagnosis of complications and in most cases, the successful treatment of leaks. When bleeding is suspected or documented, appropriate volume replacement therapy is mandatory to maintain adequate hemodynamic parameters. Drain output may orient the surgeon to take preventive measures such as discontinuing anticoagulation and early fluid resuscitation. In this series, in most cases the bleeding spontaneously stopped and no further surgical management was required.
作者回顾了腹腔镜Roux-en-Y胃旁路术（LRYGBP）后常规在腹腔内放置闭式引流管的益处。本研究的目的是确定在出现出血和渗漏等并发症时，常规闭式腹腔引流是否具有诊断和治疗优势。
回顾性分析了2001年7月至2003年5月连续593例行LRYGBP患者的病历。所有病例均采用结肠前胃前吻合的LRYGBP术式。留置两根19F Blake闭式吸引引流管，一根置于胃空肠吻合口处，另一根置于空肠空肠吻合口处。回顾出血和渗漏的发生率，并评估引流管在诊断和处理方面的效用。
24例患者（4.4%）出现出血；其中8例的诊断基于引流管血性引流液增多和血细胞比容降低。腹腔内出血患者均无需再次手术。10例出现渗漏的患者（1.68%）中，5例（50%）在术后48小时内根据引流液的特征做出诊断。10例渗漏患者中有5例（50%）通过引流和全胃肠外营养进行非手术治疗。该系列病例无死亡病例。
LRYGBP术后常规使用腹腔引流管似乎有益。引流管有助于早期诊断并发症，且在大多数情况下能成功治疗渗漏。当怀疑或证实有出血时，必须进行适当的容量替代治疗以维持足够的血流动力学参数。引流液情况可指导外科医生采取预防措施，如停用抗凝药和早期液体复苏。在本系列病例中，大多数情况下出血可自行停止，无需进一步手术处理。
