Carrodeguas Lester, Szomstein Samuel, Zundel Natan, Lo Menzo Emanuel, Rosenthal Raul
The Bariatric Institute, Cleveland Clinic Florida, Weston, Florida 33331, USA.
Surg Obes Relat Dis. 2006 Mar-Apr;2(2):92-7. doi: 10.1016/j.soard.2005.10.014.
The development of an anastomotic stricture at the site of the gastrojejunostomy following Roux-en-Y gastric bypass (RYGBP) is associated with substantial morbidity. Various techniques are available for creating the gastrojejunal anastomosis, including hand-sewing and using a circular or linear stapler, to reduce complication rates. The aim of this study was to assess the incidence of gastrojejunal anastomotic strictures in patients who underwent antecolic antegastric Roux-en-Y gastric bypass (AA-RYGBP) with the use of a linear stapler and to evaluate the outcomes of endoscopic pneumatic dilatation as a treatment option for patients with anastomotic stricture.
All patients who met the National Institutes of Health (NIH) criteria for bariatric surgery and underwent AA-RYGBP using a linear stapler technique between July 2000 and November 2004 were included in the study. Following Institutional Review Board approval, the medical records of these patients were retrospectively reviewed. Two surgeons performed all of the surgical procedures in this series using a standardized surgical protocol.
Between July 2000 and November 2004, 1291 patients (1016 females [79%] and 275 male [11%]) underwent AA-RYGBP. The patients' mean age was 43 years (range, 19-75 years), and mean preoperative body mass index (BMI) was 49.6 kg/m2 (range, 34-97.5 kg/m2). Out of 1291 procedures, 1265 were performed laparoscopically (98.3%), with the reminder performed by laparotomy. A linear stapler was used to create the gastrojejunal anastomosis in all of the procedures. A total of 405 (31%) complications occurred, with gastrojejunal anastomotic strictures the most common complication, found in 94 (7.3%) patients more than 30 days after the procedure. All of these cases of stricture were treated by endoscopic pneumatic dilatation with a through the scope (TTS) balloon, requiring between one and four dilatory sessions. Of the 94 patients (2.1%) who underwent balloon dilatation, 2 developed perforation, only 1 of whom required surgical intervention. The mean postoperative hospital stay for the 94 patients was 4.2 days (range, 2-24 days); there was no perioperative patient mortality.
Our results demonstrate that AA-RYGBP can attain a relatively low complication rate and no mortality. Gastrojejunal anastomotic strictures were the most common complication and were diagnosed 30 days after the procedure. Endoscopic balloon dilatation can be offered as a first-line treatment for gastrojejunal anastomotic strictures. Perforation is a potential complication of this treatment and may necessitate surgical intervention.
Roux-en-Y胃旁路术（RYGBP）后胃空肠吻合口处吻合口狭窄的发生与相当高的发病率相关。有多种技术可用于构建胃空肠吻合，包括手工缝合以及使用圆形或线性吻合器，以降低并发症发生率。本研究的目的是评估采用线性吻合器行结肠前胃前Roux-en-Y胃旁路术（AA-RYGBP）的患者中胃空肠吻合口狭窄的发生率，并评估内镜下气囊扩张术作为吻合口狭窄患者的一种治疗选择的效果。
所有符合美国国立卫生研究院（NIH）减肥手术标准且在2000年7月至2004年11月期间采用线性吻合器技术行AA-RYGBP的患者均纳入本研究。经机构审查委员会批准后，对这些患者的病历进行回顾性分析。本系列中的所有手术均由两名外科医生按照标准化手术方案进行。
2000年7月至2004年11月期间，1291例患者（1016例女性[79%]和275例男性[11%]）接受了AA-RYGBP。患者的平均年龄为43岁（范围19 - 75岁），术前平均体重指数（BMI）为49.6kg/m²（范围34 - 97.5kg/m²）。在1291例手术中，1265例（98.3%）通过腹腔镜完成，其余通过开腹完成。所有手术均使用线性吻合器构建胃空肠吻合。共发生405例（31%）并发症，胃空肠吻合口狭窄是最常见的并发症，在术后30天以上的94例（7.3%）患者中发现。所有这些狭窄病例均通过经内镜（TTS）气囊进行内镜下气囊扩张治疗，需要1至4次扩张疗程。在接受气囊扩张的94例患者（2.1%）中，2例发生穿孔，其中仅1例需要手术干预。这94例患者的术后平均住院时间为4.2天（范围2 - 24天）；围手术期无患者死亡。
我们的结果表明，AA-RYGBP可获得相对较低的并发症发生率且无死亡病例。胃空肠吻合口狭窄是最常见的并发症，在术后30天被诊断出来。内镜下气囊扩张可作为胃空肠吻合口狭窄的一线治疗方法。穿孔是这种治疗的一种潜在并发症，可能需要手术干预。
