Fullum Terrence M, Aluka Kanaychukwu J, Turner Patricia L
Department of Surgery, Howard University College of Medicine, Washington, DC, USA.
Surg Endosc. 2009 Jun;23(6):1403-8. doi: 10.1007/s00464-009-0370-1. Epub 2009 Mar 5.
Anastomotic and staple line leaks (ASL) occur after laparoscopic Roux-en-Y gastric bypass (LRYGB) with a reported incidence as high as 6%. Leaks are the second most common cause of post-LRYGB mortality after pulmonary embolism, and can be associated with significant morbidity. Prevention and early detection may limit both morbidity and mortality.
A retrospective analysis of prospectively collected data was performed on all LRYGBs performed in a community hospital by a single surgeon from August 2001 to December 2005. All operations were performed using a linear-stapled anastomosis with buttressing material, handsewn otomy closures, stay sutures, intraoperative leak testing, and fibrin sealant.
760 patients underwent LRYGB during the study period. Eighty-nine percent (n = 674) were female and 11% (n = 86) were male. Mean body mass index (BMI) was 50 kg/m2 (range 36-83 kg/m2). Mean age was 40 years (range 17-72 years). Two patients developed three gastric pouch staple line leaks (0.4%). There were no mortalities.
Operative technique, including appropriate staple sizing, staple line reinforcement, handsewn otomy closures, placement of stay sutures, intraoperative leak testing, and placement of fibrin sealant contributed to a lower than expected incidence of ASL after LRYGB in this series.
吻合口及吻合钉线漏（ASL）发生于腹腔镜Roux-en-Y胃旁路术（LRYGB）后，报道的发生率高达6%。漏是LRYGB术后仅次于肺栓塞的第二大常见死亡原因，且可能伴有严重的发病情况。预防和早期检测可能会降低发病率和死亡率。
对2001年8月至2005年12月期间在一家社区医院由一名外科医生实施的所有LRYGB手术进行前瞻性收集数据的回顾性分析。所有手术均采用带支撑材料的线性吻合钉吻合、手工缝合胃切开闭合、留置缝线、术中漏检测和纤维蛋白密封剂。
在研究期间，760例患者接受了LRYGB手术。89%（n = 674）为女性，11%（n = 86）为男性。平均体重指数（BMI）为50 kg/m²（范围36 - 83 kg/m²）。平均年龄为40岁（范围17 - 72岁）。2例患者出现3处胃囊吻合钉线漏（0.4%）。无死亡病例。
手术技术，包括合适的吻合钉尺寸、吻合钉线加固、手工缝合胃切开闭合、留置缝线的放置、术中漏检测以及纤维蛋白密封剂的放置，使得本系列LRYGB术后ASL的发生率低于预期。
