Blackstone Robin P, Rivera Lisa A
Scottsdale Bariatric Center at Scottsdale Healthcare, 10200 N. 92nd Street, Suite 225, Scottsdale, AZ 85258, USA.
J Gastrointest Surg. 2007 Apr;11(4):403-9. doi: 10.1007/s11605-007-0135-x.
Gastrojejunostomy stricture after Roux-en-Y gastric bypass occurs in 3 to 27% of morbidly obese patients in the USA. We questioned whether preoperative patient characteristics, including demographic attributes and comorbid disease, might be significant factors in the etiology of stricture. In this study from November 2001 to February 2006 (51 months), at a high-volume bariatric center, of the 1,351 patients who underwent laparoscopic gastric bypass, 92 developed stricture (6.8%). All but two were treated successfully by endoscopic dilation. All patients stopped nonsteroidal anti-inflammatory medications 2 weeks prior to surgery and did not restart them. The operative procedure included the use of a 21-mm transoral circular stapler to create the gastrojejunostomy; the Roux limb was brought retrogastric, retrocolic. In an effort to reduce our center's stricture rate, late in the study, U-clips used at the gastrojejunostomy were replaced by absorbable sutures, and postoperative H2 antagonists were added to the treatment protocol. The change to absorbable polyglactin suture proved to be significant, resulting in a lower stricture rate. The addition of H2 antagonists showed no significant effect. Following the retrospective review of the prospective database, univariate and multivariate logistic regression analyses identified factors associated with the development of stricture. Gastroesophageal reflux disease and age were each shown to be statistically significant independent predictors of stricture following laparoscopic gastric bypass.
在美国,接受Roux-en-Y胃旁路手术的病态肥胖患者中,胃空肠吻合口狭窄的发生率为3%至27%。我们质疑术前患者特征,包括人口统计学特征和合并疾病,是否可能是狭窄病因中的重要因素。在这项于2001年11月至2006年2月(51个月)进行的研究中,在一家大型减肥中心,1351例行腹腔镜胃旁路手术的患者中有92例发生狭窄(6.8%)。除2例患者外,其余均通过内镜扩张成功治疗。所有患者在手术前2周停用非甾体类抗炎药,术后也未重新使用。手术操作包括使用21毫米经口圆形吻合器进行胃空肠吻合;Roux肠袢经胃后、结肠后引出。为降低我们中心的狭窄发生率,在研究后期,胃空肠吻合处使用的U形夹被可吸收缝线取代,且术后治疗方案中增加了H2拮抗剂。结果证明,改用可吸收聚乙醇酸缝线具有显著效果,使狭窄发生率降低。添加H2拮抗剂未显示出显著效果。在对前瞻性数据库进行回顾性分析后,单因素和多因素逻辑回归分析确定了与狭窄发生相关的因素。胃食管反流病和年龄均被证明是腹腔镜胃旁路手术后狭窄的统计学显著独立预测因素。