Cho Minyoung, Kaidar-Person Orit, Szomstein Samuel, Rosenthal Raul J
Department of Surgery, Bariatric Institute and Section of Minimal Invasive Surgery, Cleveland Clinic Florida, Weston, Florida, USA.
Surg Obes Relat Dis. 2008 Mar-Apr;4(2):104-9. doi: 10.1016/j.soard.2007.05.008. Epub 2007 Nov 5.
Patients can be symptomatic after laparoscopic Roux-en-Y gastric bypass because of either surgical complications or physiologic changes and adjustment to the new anatomy. The aim of this study was to evaluate the factors that could influence the rate of postoperative emergency room admissions (ERAs) and the clinical implication of these visits for patients who have undergone laparoscopic Roux-en-Y gastric bypass.
The medical records of patients who underwent laparoscopic Roux-en-Y gastric bypass for morbid obesity from 2001 to 2004 were retrospectively reviewed. The data of patients with a history of an ERA after surgery was compared with the data of patients without a history of ERAs. The data collected included demographics, weight, body mass index, operative time, and more. The ERAs were subdivided into early ERAs and late ERAs, and the data were analyzed further.
Of 733 patients, 228 (31.1%) had a history of ERAs. Patients with early postoperative complication (<7 days after the procedure) had a greater rate of ERAs (60.9% versus 30.1%, P <.05). The operative time was significantly longer in the ERA group (91.4 versus 86.5 min). The most frequent complaint in the emergency room was abdominal pain (61.4%) followed by vomiting (35.5%). Gastric outlet obstruction was the most frequent cause of an ERA within 2 weeks after surgery. Most patients were treated conservatively.
Our results suggest that the rate of potential ERAs should not be disregarded. A prolonged operative time and early postoperative complications were significant predictors for late ERAs. Abdominal pain with or without vomiting was the most common presenting symptom. Most patients can be treated conservatively.
腹腔镜Roux-en-Y胃旁路术后患者可能出现症状，原因包括手术并发症或生理变化以及对新解剖结构的适应。本研究的目的是评估可能影响术后急诊室入院率（ERA）的因素以及这些就诊对接受腹腔镜Roux-en-Y胃旁路手术患者的临床意义。
回顾性分析2001年至2004年因病态肥胖接受腹腔镜Roux-en-Y胃旁路手术患者的病历。将有术后ERA病史的患者数据与无ERA病史的患者数据进行比较。收集的数据包括人口统计学、体重、体重指数、手术时间等。ERA分为早期ERA和晚期ERA，并对数据进行进一步分析。
733例患者中，228例（31.1%）有ERA病史。术后早期并发症（术后<7天）患者的ERA发生率更高（60.9%对30.1%，P<.05）。ERA组的手术时间明显更长（91.4对86.5分钟）。急诊室最常见的主诉是腹痛（61.4%），其次是呕吐（35.5%）。胃出口梗阻是术后2周内ERA最常见的原因。大多数患者接受保守治疗。
我们的结果表明，潜在的ERA发生率不容忽视。手术时间延长和术后早期并发症是晚期ERA的重要预测因素。伴有或不伴有呕吐的腹痛是最常见的表现症状。大多数患者可以接受保守治疗。
