Department of Surgery, Hôpital du Chablais, 1860 Aigle-Monthey, Switzerland.
Obes Surg. 2010 Jul;20(7):841-5. doi: 10.1007/s11695-010-0179-y.
Roux-en-Y gastric bypass (RYGBP) is one of the most commonly performed bariatric procedures for morbidly obese patients. It is associated with effective long-term weight loss, but can lead to significant complications, especially at the gastrojejunostomy (GJS). All the patients undergoing laparoscopic RYGBP at one of our two institutions were included in this study. The prospectively collected data were reviewed retrospectively for the purpose of this study, in which we compared two different techniques for the construction of the GJS and their effects on the incidence of complications. In group A, anastomosis was performed on the posterior aspect of the gastric pouch. In group B, it was performed across the staple line used to form the gastric pouch. A 21-mm circular stapler was used in all patients. A total of 1,128 patients were included between June 1999 and September 2009-639 in group A and 488 in group B. Sixty patients developed a total of 65 complications at the GJS, with 14 (1.2%) leaks, 42 (3.7%) strictures, and 9 (0.8%) marginal ulcers. Leaks (0.2% versus 2%, p = 0.005) and strictures (0.8% versus 5.9%, p < 0.0001) were significantly fewer in group B than in group A. Improved surgical technique, as we propose, with the GJS across the staple line used to form the gastric pouch, significantly reduces the rate of anastomotic complications at the GJS. A circular 21-mm stapler can be used with a low complication rate, and especially a low stricture rate. Additional methods to limit complications at the GJS are probably not routinely warranted.
胃旁路术（RYGBP）是治疗病态肥胖患者最常用的减肥手术之一。它与有效的长期体重减轻相关，但可能导致显著的并发症，尤其是在胃空肠吻合术（GJS）处。我们的两个机构之一的所有接受腹腔镜 RYGBP 的患者都被纳入了这项研究。为了进行这项研究，我们回顾性地审查了前瞻性收集的数据，比较了两种不同的 GJS 构建技术及其对并发症发生率的影响。在 A 组中，吻合术在胃袋的后侧面进行。在 B 组中，吻合术横跨用于形成胃袋的吻合钉线进行。所有患者均使用 21mm 圆形吻合器。1999 年 6 月至 2009 年 9 月期间共纳入 1128 例患者- A 组 639 例，B 组 488 例。共有 60 例患者在 GJS 处发生了 65 种并发症，其中 14 例（1.2%）发生漏，42 例（3.7%）发生狭窄，9 例（0.8%）发生边缘溃疡。B 组的漏（0.2%对 2%，p=0.005）和狭窄（0.8%对 5.9%，p<0.0001）发生率明显低于 A 组。我们提出的通过 GJS 横跨用于形成胃袋的吻合钉线进行手术技术的改进，显著降低了 GJS 吻合口并发症的发生率。使用 21mm 圆形吻合器可降低并发症发生率，尤其是狭窄发生率。可能不需要常规采用其他方法来限制 GJS 处的并发症。
