Madan Atul K, Harper Jason L, Tichansky David S
Minimally Invasive Surgery Section, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA.
Surg Obes Relat Dis. 2008 Mar-Apr;4(2):166-72; discussion 172-3. doi: 10.1016/j.soard.2007.08.006. Epub 2007 Dec 19.
Various techniques have been used for laparoscopic gastric bypass. This study was performed to survey American Society for Bariatric Surgery practicing surgeons on how they perform laparoscopic gastric bypass.
An Internet-based survey was sent to all practicing surgeons in the American Society for Bariatric Surgery database by way of e-mail. The survey was divided into sections, including experience, pouch, limbs, gastrojejunostomy (GJ), jejunojejunostomy, and band. The survey results were collected from the Internet site after 4 months.
A total of 215 surgeons responded; 98% stated they performed laparoscopic gastric bypass. The surgeons had performed an average of 423 cases in their career and 95 cases during the past 12 months. The average pouch size was 25 cm(3) and approximately one half of the surgeons (49%) measured the pouch size by the distance for the gastroesophageal junction. Almost all surgeons (99.5%) performed Roux-en-Y and not loop GJ. The average biliopancreatic limb length was 48 cm, and the average Roux limb was 114 cm. About one half of the surgeons (46%) measured the limb length with an open grasper, and few (7%) used a suture or umbilical tape. The antecolic and antegastric approaches were the more common. The percentage of those using the circular stapler, linear stapler, and hand sewing was 43%, 41%, and 21% for the GJ technique. Most surgeons (93%) routinely tested the GJ intraoperatively. The percentage of those using staple anastomosis and hand-sewn common enterotomy, double stapling, triple stapling, and hand sewing was 53%, 36%, 13%, and 1% for the jejunojejunostomy technique. Most surgeons (94%) closed at least one mesenteric defect. Also, most surgeons (95%) did not place a band around the pouch.
Technical variations exist in how laparoscopic gastric bypass procedures are performed by American Society for Bariatric Surgery practicing surgeons. Additional research is needed to explore the links between the technical variations and outcomes.
腹腔镜胃旁路手术有多种技术。本研究旨在调查美国肥胖症外科学会的执业外科医生如何进行腹腔镜胃旁路手术。
通过电子邮件向美国肥胖症外科学会数据库中的所有执业外科医生发送基于互联网的调查问卷。该问卷分为多个部分，包括经验、胃囊、肠袢、胃空肠吻合术（GJ）、空肠空肠吻合术和束带。4个月后从互联网网站收集调查结果。
共有215名外科医生回复；98%表示他们进行腹腔镜胃旁路手术。这些外科医生在其职业生涯中平均进行了423例手术，在过去12个月中平均进行了95例手术。胃囊平均大小为25立方厘米，约一半的外科医生（49%）通过食管胃交界处的距离来测量胃囊大小。几乎所有外科医生（99.5%）采用Roux-en-Y式而非袢式GJ。胆胰袢平均长度为48厘米，Roux袢平均长度为114厘米。约一半的外科医生（46%）用开放抓钳测量肠袢长度，很少（7%）使用缝线或脐带来测量。结肠前和胃前入路更为常见。对于GJ技术，使用圆形吻合器、线性吻合器和手工缝合的比例分别为43%、41%和21%。大多数外科医生（93%）在术中常规测试GJ。对于空肠空肠吻合术技术，使用吻合器吻合、手工缝合共同肠切开术、双重吻合、三重吻合和手工缝合的比例分别为53%、36%、13%和1%。大多数外科医生（94%）至少闭合一个肠系膜缺损。此外，大多数外科医生（95%）不在胃囊周围放置束带。
美国肥胖症外科学会的执业外科医生在进行腹腔镜胃旁路手术的方式上存在技术差异。需要进一步研究来探索这些技术差异与手术结果之间的联系。
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