Section of Bariatric Surgery, Division of General Surgery, McGill University Health Center, Montreal, Quebec, Canada.
Surg Obes Relat Dis. 2010 Jan-Feb;6(1):46-9. doi: 10.1016/j.soard.2009.03.002. Epub 2009 Mar 17.
Fibrin sealants (FSs) have been used in both open and laparoscopic bariatric surgery to decrease the anastomotic leak rate; however, conclusive evidence to recommend routine use is still lacking. We studied FS use and its effect on the clinical inflammatory response after laparoscopic Roux-en-Y gastric bypass.
Of 474 consecutive patients scheduled to undergo laparoscopic Roux-en-Y gastric bypass, 158 were assigned to group 1 (no FS used), 158 were assigned to group 2 (FS used at the gastrojejunal anastomosis and gastric staple line), and 158 patients were assigned to group 3 (reverting back to no FS use).
The mean age of all patients was 40.7 years (range 18-64), and the mean body mass index was 51.9 kg/m(2) (range 36.7-107). The FS group had a statistically significant higher pulse rate (P = .001), recorded temperature (P = .001), and white blood cell count (P = .001) in the first 48 hours after surgery. The overall leak rate was 4.2% (20 of 474 cases). The mortality rate was 0% in all 3 groups. FS use had no effect on the anastomosis or staple line leak rate. An evaluation for fever of unknown origin was required in 6 patients in the FS group with no evidence of leak. Of these 6 patients, 4 had no evidence of leak on upper gastrointestinal series or computed tomography and 2 underwent surgical exploration with a subphrenic collection found but no evidence of leak intraoperatively (negative findings for pneumatic and methylene blue tests).
FS use in laparoscopic Roux-en-Y gastric bypass is associated with an increased clinical inflammatory response mimicking anastomotic leak. FS had no effect on the anastomotic leak rate.
纤维蛋白粘合剂（FS）已被用于开放和腹腔镜减重手术中，以降低吻合口漏的发生率；然而，仍然缺乏推荐常规使用的明确证据。我们研究了 FS 的使用及其对腹腔镜 Roux-en-Y 胃旁路术后临床炎症反应的影响。
在 474 例连续接受腹腔镜 Roux-en-Y 胃旁路术的患者中，158 例患者被分为第 1 组（未使用 FS），158 例患者被分为第 2 组（FS 用于胃空肠吻合口和胃钉合线），158 例患者被分为第 3 组（恢复不使用 FS）。
所有患者的平均年龄为 40.7 岁（范围 18-64 岁），平均体重指数为 51.9kg/m²（范围 36.7-107）。FS 组在术后 48 小时内的脉搏率（P =.001）、记录温度（P =.001）和白细胞计数（P =.001）均显著升高。总体漏率为 4.2%（474 例中有 20 例）。三组死亡率均为 0%。FS 的使用对吻合口或钉合线漏率没有影响。在使用 FS 的 6 例患者中，有 6 例出现原因不明的发热，无漏诊证据。在这 6 例患者中，4 例上消化道造影或 CT 无漏诊证据，2 例接受了手术探查，发现膈下积液，但术中无漏诊证据（气动和亚甲蓝试验均为阴性）。
FS 在腹腔镜 Roux-en-Y 胃旁路术中的使用与模仿吻合口漏的临床炎症反应增加有关。FS 对吻合口漏发生率没有影响。
