Sekhar N, Torquati A, Lutfi R, Richards W O
Department of Surgery, Vanderbilt University Medical School, D-5219 MCN, Nashville, TN 37232, USA.
Surg Endosc. 2006 Feb;20(2):199-201. doi: 10.1007/s00464-005-0118-5. Epub 2005 Dec 5.
A significant and potentially deadly complication of the Roux-en-Y gastric bypass is leakage from the gastrojejunostomy (GJ). The aim of our study was to evaluate the efficacy of intraoperative endoscopy in preventing postoperative anastomotic leakage.
The study enrolled 340 consecutive patients undergoing laparoscopic gastric bypass procedures performed from January 2001 to July 2004. In all cases, an endoscopist performed video gastroscopy to evaluate the integrity of the GJ using air insufflation of the pouch after distal clamping of the Roux limb. Intraoperative leaks were repaired and the anastomosis was retested. Demographic, operative, and endoscopic data were collected and analyzed. Logistic regression was used in both univariate and multivariate modeling to identify independent preoperative variables associated with the presence of intraoperative leak. Model parameters were estimated by the maximum likelihood method. From these estimates, odds ratios (ORs) with 95% confidence intervals (CIs) were computed.
There were no postoperative anastomotic leaks or mortalities in our series. Overall, endoscopic evaluation of the GJ resulted in the detection of 56 intraoperative leaks (16.4%). There was a significant difference in the incidence of intraoperative leakage for patients older than 40 years (21%) vs those younger than 40 years (10.5%; p = 0.01). In the initial 91 cases, the GJ was performed by the end-to-end anastomosis (EEA) technique; the subsequent 249 were performed with a combination of linear stapling and handsewn technique. There was a trend toward more leakage in the GIA group (18%) versus EEA (12%); however, the difference was not significant (p = 0.188). Age remained an independent risk factor for leak detected intraoperatively in the multivariate logistic regression model after adjusting for covariates. Age >40 years increased the risk of intraoperative leakage by 2.3 times (OR, 2.3; 95% CI, 1.2-4.6; p = 0.01). The rate of postoperative anastomotic stricture was the same among patients detected with an intraoperative leak (5.4%) and those without (5.6%; p = 0.934).
Endoscopic evaluation of the GJ is a sensitive and reliable technique for demonstrating anastomotic integrity and preventing postoperative morbidity after gastric bypass. Age >40 years was identified as an independent risk factor for intraoperative leak in this series.
Roux-en-Y胃旁路手术一种严重且可能致命的并发症是胃空肠吻合口漏。本研究的目的是评估术中内镜检查在预防术后吻合口漏方面的疗效。
本研究纳入了2001年1月至2004年7月连续接受腹腔镜胃旁路手术的340例患者。在所有病例中，内镜医师在Roux肠袢远端钳夹后，通过向胃囊内注入空气进行视频胃镜检查，以评估胃空肠吻合口的完整性。术中发现的漏口进行修复，并重新检测吻合口。收集并分析人口统计学、手术和内镜数据。在单变量和多变量模型中均使用逻辑回归来确定与术中漏口存在相关的独立术前变量。通过最大似然法估计模型参数。根据这些估计值，计算9
