Department of Surgery, Minimally Invasive Surgery, Emory University Hospital, 1364 Clifton Road, NE, Atlanta, GA 30322, USA.
Obes Surg. 2010 Jul;20(7):846-50. doi: 10.1007/s11695-008-9761-y. Epub 2008 Nov 18.
BACKGROUND: The stapled gastrojejunostomy of the laparoscopic Roux-en-Y gastric bypass (LRYGBP) can be created by linear and circular stapling techniques. In the circular-stapled technique, the anvil of the stapler can be introduced into the gastric pouch transabdominally or pulled down the esophagus (transorally) by attachment to a modified gastric tube. The purpose of this study is to determine if the transoral technique to introduce the anvil will reduce operative time and cost compared with the transabdominal technique, which requires creating a new gastrotomy to insert the anvil and followed by its closure. METHODS: We compared 60 consecutive morbidly obese patients who underwent laparoscopic RYGBP. First 30 cases were performed by transabdominal anvil insertion, followed by 30 cases using transoral anvil insertion. All of the transabdominal cases were assisted by experienced fellows. The first ten transoral cases were assisted by experienced fellows and the remaining 20 by new fellows in order to evaluate if the transoral technique shortens the learning curve. Surgery duration and operative costs were compared. Complications (bleeding, leaks, anastomotic strictures, ulcers, wound infections) and length of stay were also evaluated. Data are expressed as mean +/- SD. RESULTS: Mean operative time was shorter in the transoral group compared with the transabdominal group (162.2 +/- 35.8 vs. 186 +/- 33.6 min respectively, p = 0.01), even though most of the transoral cases (n = 20) were assisted by new fellows and all of the transabdominal cases by experienced fellows. Operative times were not different between new and experienced fellows in the transoral technique. Supply costs per patient were higher in the transabdominal technique compared with the transoral technique (2,983.5 +/- 540.9 vs. 2,658.8 +/- 474.4 USD, respectively, p = 0.03). Perioperative complications and length of stay were not statistically different. CONCLUSION: The transoral introduction of the anvil of the circular stapler into the gastric pouch is a simple, safe, and efficient technique for creating the gastrojejunostomy in laparoscopic RYGBP. In addition, the transoral technique is less expensive and appears to accelerate the learning curve compared with the transabdominal technique.
背景：腹腔镜 Roux-en-Y 胃旁路术（LRYGBP）的吻合可以通过线性和圆形吻合技术来完成。在圆形吻合技术中，吻合器的吻合钉座可以通过经腹部或通过附着在改良胃管下拉入食管（经口）进入胃袋。本研究的目的是确定经口技术引入吻合钉座是否会减少手术时间和成本，而经腹部技术需要创建新的胃造口术来插入吻合钉座，然后关闭。
方法：我们比较了 60 例连续行腹腔镜 RYGBP 的病态肥胖患者。前 30 例经腹部插入吻合钉座，随后 30 例经口插入吻合钉座。所有经腹部的病例均由经验丰富的医师协助完成。前 10 例经口病例由经验丰富的医师协助，其余 20 例由新医师协助，以评估经口技术是否缩短学习曲线。比较手术时间和手术费用。还评估了并发症（出血、漏液、吻合口狭窄、溃疡、伤口感染）和住院时间。数据表示为平均值 +/- SD。
结果：与经腹部组相比，经口组的手术时间更短（分别为 162.2 +/- 35.8 分钟和 186 +/- 33.6 分钟，p = 0.01），尽管大多数经口病例（n = 20）由新医师协助完成，而所有经腹部病例均由经验丰富的医师协助完成。经口技术中，新医师和经验丰富医师的手术时间没有差异。与经口技术相比，经腹部技术的每个患者的供应成本更高（分别为 2,983.5 +/- 540.9 美元和 2,658.8 +/- 474.4 美元，p = 0.03）。围手术期并发症和住院时间无统计学差异。
结论：经口引入圆形吻合器的吻合钉座是一种简单、安全、有效的腹腔镜 RYGBP 胃空肠吻合术方法。此外，与经腹部技术相比，经口技术成本更低，且似乎可以加快学习曲线。
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