Sczepaniak John P, Owens Milton L
Coastal Center for Obesity, San Pedro, California 90731, USA.
Surg Obes Relat Dis. 2009 Jan-Feb;5(1):77-80. doi: 10.1016/j.soard.2008.10.005. Epub 2008 Nov 1.
The incidence of strictures developing after gastrojejunostomy has been reported to range from 3% to 31%. We found an unacceptably high stricture rate (13%) using a 21-mm circular stapler. Attempts to use the 25-mm circular stapler were frustrated by disparities between the size of the instrument and the patient's anatomy. We, therefore, modified the technique to accomplish the anastomosis with the linear stapler and hand sewing (LSA) at community hospitals in Southern California.
A total of 124 anastomoses were accomplished with the circular stapler (CSA) followed by 100 anastomoses using the LSA technique. Drains were used routinely with the CSA technique but were used only selectively with the LSA technique. Stricture was defined as that requiring endoscopic dilation for symptoms. Leaks were confirmed radiologically or surgically, and bleeding was defined as the need for transfusion. Our analysis used the Student t test and Fisher's exact test, with P <.05 considered statistically significant.
No patient died. The LSA technique was faster and resulted in significantly fewer postoperative strictures and complications compared with the CSA technique.
The results of our study have shown that the LSA technique, as described, is preferable to the CSA technique.
据报道，胃空肠吻合术后狭窄的发生率在3%至31%之间。我们发现使用21毫米圆形吻合器时狭窄率高得令人难以接受（13%）。尝试使用25毫米圆形吻合器时，因器械尺寸与患者解剖结构之间的差异而受挫。因此，我们在南加州的社区医院改进了技术，采用线性吻合器和手工缝合（LSA）来完成吻合。
先用圆形吻合器（CSA）完成了124例吻合，随后用LSA技术完成了100例吻合。CSA技术常规使用引流管，而LSA技术仅选择性使用。狭窄定义为因症状需要内镜扩张。渗漏通过放射学或手术确诊，出血定义为需要输血。我们的分析采用Student t检验和Fisher精确检验，P <.05被认为具有统计学意义。
无患者死亡。与CSA技术相比，LSA技术更快，术后狭窄和并发症明显更少。
我们的研究结果表明，所述的LSA技术优于CSA技术。
