Ruiz de Adana Juan Carlos, Hernández Matías Alberto, Hernández Bartolomé Miguel, Manzanedo Romero Israel, Leon Ledesma Raquel, Valle Rubio Ainhoa, López Herrero Julio, Limones Esteban Manuel
Cirugía General y Digestivo, Hospital Universitario de Getafe, Crta Toledo Km 12.5, 28905-Getafe, Madrid, Spain.
Obes Surg. 2009 Sep;19(9):1274-7. doi: 10.1007/s11695-009-9897-4. Epub 2009 Jun 26.
Gastrojejunal (GJ) stricture is one of the most common late complications after laparoscopic Roux-en-Y gastric bypass (LRYGBP) with a hand-sewn anastomosis. The object of this study was to assess the risk of stricture for two types of resorbable suture (multifilament and monofilament) in a series of LRYGBPs performed by the same surgeon.
Prospective cohort study. The study population consisted of a series of consecutive morbidly obese patients who underwent primary hand-sewn LRYGBP between March 2004 and May 2008 at the University Hospital in Getafe, Madrid, Spain. The study comprised 242 LRYGBPs with a four-layer continuous hand-sewn anastomosis using absorbable 3/0 gauge suture. The suture material was Ethicon Vicryl multifilament in the first 105 cases and Ethicon Monocryl monofilament in the following 137 cases. All patients were followed up monthly for the first 6 months and then every 6 months after that.
The mean BMI was 46 +/- 4 for the multifilament cohort and 48 +/- 6 for the monofilament cohort with no significant difference between the two (p = 0.567). There were no anastomotic leaks, and no cases of marginal ulcer, abscess, abdominal sepsis, deep vein thrombosis, or pulmonary embolism were recorded. No cases required conversion to open surgery, and perioperative mortality was zero. In all, 11 cases of stricture (4.4%) were recorded, 10 in the multifilament suture cohort (9.5%), and only one in the monofilament suture cohort (0.7%; p = 0.001). The odds ratio was 14.3 (95% CI = 1.8-113.4). The mean outpatient follow-up period was 30 months (range = 6-42).
Anastomotic GJ stricture is a common and well-known complication of laparoscopic gastric bypass for morbid obesity. Hand sewing with monofilament suture significantly lowered the frequency of this complication, and hence, monofilament should be the suture material of choice for this suturing technique.
胃空肠（GJ）狭窄是腹腔镜Roux-en-Y胃旁路术（LRYGBP）采用手工缝合吻合术后最常见的晚期并发症之一。本研究的目的是评估在同一外科医生实施的一系列LRYGBP手术中，两种可吸收缝线（多股和单股）导致狭窄的风险。
前瞻性队列研究。研究人群包括2004年3月至2008年5月期间在西班牙马德里赫塔费大学医院接受初次手工缝合LRYGBP的一系列连续的病态肥胖患者。该研究包括242例LRYGBP手术，采用可吸收3/0规格缝线进行四层连续手工缝合吻合。前105例病例使用Ethicon Vicryl多股缝线，后137例病例使用Ethicon Monocryl单股缝线。所有患者在术后前6个月每月随访一次，之后每6个月随访一次。
多股缝线组的平均体重指数为46±4，单股缝线组为48±6，两组之间无显著差异（p = 0.567）。无吻合口漏，未记录到边缘溃疡、脓肿、腹腔感染、深静脉血栓形成或肺栓塞病例。无病例需要转为开放手术，围手术期死亡率为零。总共记录到11例狭窄（4.4%），多股缝线组10例（9.5%），单股缝线组仅1例（0.7%；p = 0.001）。比值比为14.3（95%可信区间 = 1.8 - 113.4）。门诊平均随访期为30个月（范围 = 6 - 42个月）。
吻合口GJ狭窄是腹腔镜胃旁路术治疗病态肥胖常见且广为人知的并发症。使用单股缝线手工缝合可显著降低该并发症的发生率，因此，单股缝线应是这种缝合技术的首选缝线材料。
