University of Wisconsin School of Medicine and Public Health and UW Health Bariatric Surgery Program, USA.
Surg Obes Relat Dis. 2010 Jan-Feb;6(1):64-7. doi: 10.1016/j.soard.2009.05.006. Epub 2009 Jun 23.
To determine the effect of bovine pericardium strip (BPS) reinforcement of the circular stapler on the gastrojejunostomy leak rates and staple line failure after laparoscopic Roux-en-Y gastric bypass (LRYGB) at a university hospital in the United States. Gastrojejunostomy leak after LRYGB is a devastating complication. Various techniques, including buttressing the gastrojejunostomy staple line with biomaterial, have been used in an effort to minimize leaks.
A total of 350 consecutive patients underwent LRYGB without staple line buttressing. After this initial experience, BPS reinforcement of the gastrojejunostomy was conducted in 81 consecutive patients. BPS reinforcement was not used for the final 69 consecutive patients in this 500 patient series. Circular staple line failures (intraoperative immediate and complete failure of the anastomosis) and leaks were evaluated retrospectively.
Three leaks (and no intraoperative staple line failures) occurred in 419 patients without BPS buttressing, all in the first 100 cases of our experience, and 3 leaks and an anastomotic staple line failure occurred in the 81 patients with BPS buttressing (.7% versus 4.9%, P = .02). The body mass index and other potential leak risk factors did not differ between the 2 groups.
In our experience, buttressing of the circular staple line with BPS during LRYGB was associated with an increased staple line adverse event rate. BPS buttressing of the gastrointestinal circular staple lines should be used with caution.
在美国的一家大学医院，为了确定牛心包条（BPS）对腹腔镜 Roux-en-Y 胃旁路术（LRYGB）后胃空肠吻合口漏率和吻合口钉线失败的影响。LRYGB 后的胃空肠吻合口漏是一种破坏性的并发症。为了尽量减少漏出，各种技术，包括用生物材料支撑胃空肠吻合口钉线，都被应用。
共有 350 例连续患者接受了未用吻合口钉线支撑的 LRYGB。在这一初始经验之后，对 81 例连续患者进行了 BPS 加固胃空肠吻合术。在这 500 例患者系列中，最后 69 例患者未使用 BPS 加固。回顾性评估圆形吻合口钉线失败（术中即刻和完全吻合口失败）和漏出。
在没有 BPS 支撑的 419 例患者中，有 3 例（无术中吻合口钉线失败）发生漏出，均发生在我们经验的前 100 例中，而在 81 例有 BPS 支撑的患者中，有 3 例漏出和吻合口钉线失败（7%比 4.9%，P =.02）。两组的体重指数和其他潜在的漏出危险因素没有差异。
根据我们的经验，在 LRYGB 中使用 BPS 加固圆形吻合口钉线与增加吻合口不良事件发生率有关。BPS 加固胃肠圆形吻合口钉线应谨慎使用。
