Bakhos Charles, Alkhoury Fuad, Kyriakides Tassos, Reinhold Randolph, Nadzam Geoffrey
Department of Surgery, Hospital of Saint Raphael, MOB 315, 1450 Chapel Street, New Haven, CT, 06511, USA.
Department of Internal Medicine, Yale University School of Medicine, 950 Campbell Avenue, VA CT Healthcare System, West Haven, CT, 06516, USA.
Obes Surg. 2009 Feb;19(2):153-157. doi: 10.1007/s11695-008-9580-1. Epub 2008 Jul 16.
Early postoperative hemorrhage is an infrequent complication of both laparoscopic and open Roux-en-Y gastric bypass (RYGBP). The objective of our study is to review the incidence and management of this complication and identify contributing clinical and technical risk factors.
Over a 3-year period, 1,025 patients underwent RYGBP at our institution. The medical records of patients who required postoperative blood transfusions were reviewed for clinical presentation, diagnostic evaluation and management. These patients were matched for surgical approach (open vs. laparoscopic) in a 1:3 ratio and compared to a random group of patients who underwent RYGBP during the same time period.
Thirty-three patients (3.2%) were diagnosed with postoperative hemorrhage, 17 (51.5%) of which were intraluminal. The incidence of hemorrhage was higher in the laparoscopic group (5.1% vs. 2.4%, p = 0.02). Comparing bleeders to nonbleeders, the average BMI, gender distribution, gastro-jejunostomy anastomotic technique (stapled vs. hand sewn) and the postoperative administration of ketorolac were not significantly different. The bleeding group was older (47.5 vs. 42.8, p = 0.02), had a longer hospital stay (4.9 vs. 3 days, p = 0.0001) and was more likely to have received low molecular weight heparin (LMWH) preoperatively (p = 0.03). Hemorrhage occurred earlier (13.8 vs. 25.9 h, p = 0.039) and was more severe (4.1 vs. 2.3 transfused blood units, p = 0.007) in the patients who required surgical reexploration (n = 9).
A laparoscopic approach and the preoperative administration of LMWH may increase the incidence of early hemorrhage after RYGBP. This complication frequently requires surgical reexploration and significantly prolongs the hospital stay.
术后早期出血是腹腔镜和开放式Roux-en-Y胃旁路术（RYGBP）均较少见的并发症。本研究的目的是回顾该并发症的发生率及处理方法，并确定相关的临床和技术风险因素。
在3年期间，我院有1025例患者接受了RYGBP手术。对需要术后输血的患者的病历进行回顾，以了解其临床表现、诊断评估和处理情况。这些患者按照手术方式（开放手术与腹腔镜手术）以1:3的比例进行匹配，并与同期接受RYGBP手术的随机分组患者进行比较。
33例患者（3.2%）被诊断为术后出血，其中17例（51.5%）为腔内出血。腹腔镜组的出血发生率较高（5.1%对2.4%，p = 0.02）。比较出血患者与未出血患者，平均体重指数、性别分布、胃肠吻合吻合技术（吻合器吻合与手工缝合）以及术后酮咯酸的使用情况无显著差异。出血组患者年龄较大（47.5对42.8，p = 0.02），住院时间较长（4.9天对3天，p = 0.0001），术前更可能接受了低分子量肝素（LMWH）治疗（p = 0.03）。需要再次手术探查的患者（n = 9）出血发生得更早（13.8小时对25.9小时，p = 0.039）且更严重（输血量4.1单位对2.3单位，p = 0.007）。
腹腔镜手术方式和术前使用LMWH可能会增加RYGBP术后早期出血的发生率。这种并发症常常需要再次手术探查，并显著延长住院时间。
