Department of Surgery, Division of General Surgery, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria.
Obes Surg. 2010 Apr;20(4):440-6. doi: 10.1007/s11695-009-9998-0. Epub 2009 Oct 24.
Different surgical techniques have been developed for the gastrojejunostomy (GJS) in laparoscopic Roux-en-Y gastric bypass (LRYGBP) with the anastomosis performed in a circular-stapled, linear-stapled, or totally hand-sewn way. No technique seems superior to the other as no consistent data on weight loss or complication rates were described.
A matched-pair study was conducted including a total of 150 patients, who underwent primary antegastric, antecolic LRYGBP between August 2003 and February 2007. Early weight loss and the incidence of GJS strictures or leaks and wound infections were compared between circular-stapled anastomosis (CSA) and linear-stapled anastomosis (LSA). Both groups were matched for age, sex, and body mass index.
Excess weight loss at 3 months was slightly better with the CSA (p = 0.002) and comparable thereafter. Percentage of excess weight loss at 6, 12, and 24 months was 55.9 +/- 17.5% vs. 51.2 +/- 14.5%, 69.5 +/- 20.9% vs. 71.4 +/- 22.6%, and 70.8 +/- 22.4% vs. 73.2 +/- 23.4%, respectively (CSA vs. LSA). Strictures at the GJS were found only in the CSA group (n = 4), and leaks were found in one patient of the CSA group. More wound infections were observed in patients of the CSA group (ten vs. one).
CSA and LSA lead to comparable early weight loss in LRYGB. Thus, the technique is the surgeon's choice. In CSA, a higher incidence of GJS strictures and wound infections was observed. As weight regain following LRYGBP is commonly observed after at least 3 years, a longer follow-up is needed to compare the incidence of weight regain in circular- vs. linear-stapled GJS.
腹腔镜 Roux-en-Y 胃旁路术（LRYGBP）中的胃空肠吻合术（GJS）已经发展出不同的手术技术，吻合方式有圆形吻合、线性吻合或全手工缝合。由于没有一致的数据描述体重减轻或并发症发生率，因此没有一种技术似乎优于其他技术。
进行了一项配对研究，共纳入 150 例患者，他们于 2003 年 8 月至 2007 年 2 月接受了原发性前胃、前结肠 LRYGBP。比较圆形吻合（CSA）和线性吻合（LSA）之间早期体重减轻和 GJS 狭窄或渗漏以及伤口感染的发生率。两组均按年龄、性别和体重指数匹配。
CSA 的术后 3 个月时的体重减轻量略好（p = 0.002），此后则相当。6、12 和 24 个月时的超重减轻百分比分别为 55.9 +/- 17.5%比 51.2 +/- 14.5%、69.5 +/- 20.9%比 71.4 +/- 22.6%和 70.8 +/- 22.4%比 73.2 +/- 23.4%（CSA 比 LSA）。GJS 狭窄仅见于 CSA 组（n = 4），CSA 组有 1 例患者出现渗漏。CSA 组的伤口感染更多（10 例比 1 例）。
CSA 和 LSA 在 LRYGB 中导致相似的早期体重减轻。因此，该技术是外科医生的选择。在 CSA 中，观察到 GJS 狭窄和伤口感染的发生率较高。由于 LRYGBP 后的体重反弹通常在至少 3 年后才会出现，因此需要更长的随访时间来比较圆形吻合与线性吻合 GJS 的体重反弹发生率。
