Andrew Christopher G, Hanna Wael, Look Didier, McLean Alexander P H, Christou Nicolas V
Department of Surgery, University of Manitoba, St. Boniface General Hospital, Winnipeg.
Can J Surg. 2006 Dec;49(6):417-21.
This study was performed to evaluate the safety and short-term efficacy of laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity and to describe the relation between learning curve and short-term outcomes.
We collected a prospective database on the first 201 consecutive patients who underwent LRYGB by a single university-based, experienced bariatric surgeon over 24 months. We divided patients into 3 consecutive groups of 67 patients for analysis (Group 1, Group 2 and Group 3).
The mean patient age was 37 (standard deviation [SD] 9) years; mean body mass index (BMI) was 49.2 (SD 8.3) kg/m2. BMI was similar in Groups 1 and 2 (mean 47.1, SD 5.9 and mean 48.7, SD 8.9 kg/m2) but increased in Group 3 (mean 52, SD 9.7 kg/m2, p < 0.01). Operative time decreased from 145 (SD 30) minutes in Group 1 to 114 (SD 24) minutes in Group 2 (p < 0.01) and was maintained at 119 (SD 23) minutes in Group 3. Early and late complication rates were 14.9% and 12.4%, respectively. Leak rates decreased from 6.0% in the first group to 1.5% in Groups 2 and 3, but they did not reach statistical significance. Anastomotic stricture rates decreased from 11.9% in Group 1 to 3.0% in Group 2 (p < 0.01). Overall excess weight loss for the entire series was 31.5% (SD 11.9%), 54.5% (SD 14.1%), 77.1% (SD 18.5%) and 82.1% (SD 17.5%) at 3, 6, 12 and 18 months, respectively.
LRYGB can be performed with acceptable morbidity and short-term results during the learning curve. In our series, operative time and anastomotic stricture rates decreased with experience, despite an increase in mean BMI.
本研究旨在评估腹腔镜Roux-en-Y胃旁路术（LRYGB）治疗病态肥胖的安全性和短期疗效，并描述学习曲线与短期结果之间的关系。
我们收集了一个前瞻性数据库，该数据库包含一所大学附属医院的一位经验丰富的减重外科医生在24个月内连续进行的首批201例LRYGB手术患者的资料。我们将患者分为连续的3组，每组67例进行分析（第1组、第2组和第3组）。
患者平均年龄为37（标准差[SD]9）岁；平均体重指数（BMI）为49.2（SD 8.3）kg/m²。第1组和第2组的BMI相似（分别为平均47.1，SD 5.9和平均48.7，SD 8.9 kg/m²），但第3组有所增加（平均52，SD 9.7 kg/m²，p<0.01）。手术时间从第1组的145（SD 30）分钟降至第2组的114（SD 24）分钟（p<0.01），第3组维持在119（SD 23）分钟。早期和晚期并发症发生率分别为14.9%和12.4%。渗漏率从第一组的6.0%降至第2组和第3组的1.5%，但未达到统计学显著性。吻合口狭窄率从第1组的11.9%降至第2组的3.0%（p<0.01）。整个系列在3、6、12和18个月时的总体超重减轻分别为31.5%（SD 11.9%）、54.5%（SD 14.1%）、77.1%（SD 18.5%）和82.1%（SD 17.5%）。
在学习曲线期间，LRYGB手术的发病率和短期结果是可接受的。在我们的系列研究中，尽管平均BMI有所增加，但手术时间和吻合口狭窄率随着经验的增加而降低。
