Sekhar N, Torquati A, Youssef Y, Wright J K, Richards W O
Department of Surgery, Vanderbilt University Medical Center, D-5219 MCN, Nashville, TN 37232, USA.
Surg Endosc. 2007 Apr;21(4):665-8. doi: 10.1007/s00464-006-9151-2. Epub 2007 Feb 7.
Laparoscopic Roux-en-Y gastric bypass surgery (RYGB) was introduced at the authors' institution 5 years ago. The authors analyzed the short- and long-term results of this procedure compared with those for the same procedure using the laparotomy approach over the same period.
Retrospective analysis of a prospectively collected bariatric database used the outcome end points used by the American Society of Bariatric Surgery (ASBS) and the American College of Surgeons (ACS) in their center of excellence programs.
From January 2001 to July 2005, 568 laparoscopic and 399 open gastric bypasses were performed at Vanderbilt University. The patients were from the same bariatric surgery program and therefore received the same pre- and postoperative care. The hospital length of stay in the laparoscopic group was significantly shorter (2.5 +/- 2.4 days) than in the open group (3.7 +/- 3.7 days; p = 0.001). The procedure time was significantly shorter in the laparoscopic group (164 +/- 50 min) than in the open group (195 +/- 50 min; p = 0.0001). The follow-up assessment response at 2 years was 76.6%. At 2 years, the excess weight loss (EWL) was significantly greater in the laparoscopic group (71.3% +/- 18.4%) than in the open group (67.3% +/- 15.3%; p = 0.03). The wound infection rate was significantly higher in open group (9.2%) than in the laparoscopic group (1.7%; p = 0.001). There was no significant difference in 30-day mortality: open (0.50%) versus laparoscopic (0.17%; p = 0.371). There was no significant difference in the 30-day reoperation rate between the open (2.4%) and laparoscopic (2.6%; p = 0.705) groups. The 30-day readmission rate was similar in the open (5.0%) and laparoscopic (5.2%; p = 0.852) groups, as was the rate of leakage from the gastrojejunostomy in the open (0.50%) and laparoscopic (0.35%; p = 0.127) groups. The conversion rate from laparoscopic procedure to laparotomy was 1.7%.
In the authors' institution, a laparoscopic bariatric surgery program with a very low rate of morbidity and mortality has been introduced. Operative time, hospital stay, and wound complications are reduced with the laparoscopic approach. The laparoscopic and open procedures are equally safe, with equivalent 30-day mortality, readmission, reoperation, and gastrojejunostomy leakage rates.
5年前，作者所在机构引入了腹腔镜Roux-en-Y胃旁路手术（RYGB）。作者分析了该手术与同期采用开腹手术方式进行相同手术的短期和长期结果。
对前瞻性收集的肥胖症数据库进行回顾性分析，采用美国肥胖症外科学会（ASBS）和美国外科医师学会（ACS）在其卓越中心项目中使用的结局终点指标。
2001年1月至2005年7月，范德比尔特大学进行了568例腹腔镜胃旁路手术和399例开腹胃旁路手术。患者来自同一个肥胖症手术项目，因此接受相同的术前和术后护理。腹腔镜组的住院时间显著短于开腹组（2.5±2.4天 vs 3.7±3.7天；p = 0.001）。腹腔镜组的手术时间显著短于开腹组（164±50分钟 vs 195±50分钟；p = 0.0001）。2年时的随访评估应答率为76.6%。2年时，腹腔镜组的超重减轻（EWL）显著高于开腹组（71.3%±18.4% vs 67.3%±15.3%；p = 0.03）。开腹组的伤口感染率显著高于腹腔镜组（9.2% vs 1.7%；p = 用腹腔镜方法可减少手术时间、住院时间和伤口并发症。腹腔镜手术和开腹手术同样安全，30天死亡率、再入院率、再次手术率和胃空肠吻合口漏率相当。001）。30天死亡率无显著差异：开腹组为0.50%，腹腔镜组为0.17%；p = 0.371）。开腹组（2.4%）和腹腔镜组（2.6%）的30天再次手术率无显著差异；p = 0.705）。开腹组（5.0%）和腹腔镜组（5.2%）的30天再入院率相似，开腹组（0.50%）和腹腔镜组（0.35%）的胃空肠吻合口漏率也相似；p = 0.127）。腹腔镜手术转为开腹手术的转换率为1.7%。
在作者所在机构，已引入了发病率和死亡率极低的腹腔镜肥胖症手术项目。
