Department of Surgery, University of California Irvine Medical Center, Orange, California 92868, USA.
Surg Obes Relat Dis. 2010 Sep-Oct;6(5):477-82. doi: 10.1016/j.soard.2010.03.294. Epub 2010 May 21.
Gastrointestinal (GI) bleeding and anastomotic stricture are frequent complications associated with the construction of the gastrojejunostomy during laparoscopic gastric bypass. Staplers with shorter staple height can reduce the rate of postoperative GI hemorrhage. The aim of the present study was to assess the outcomes of patients who had undergone gastric bypass with construction of the gastrojejunostomy using a 25-mm circular stapler with a 3.5- versus 4.8-mm staple height.
From January 2007 to February 2009, 357 patients underwent laparoscopic gastric bypass using a circular stapler for construction of the gastrojejunostomy were randomly assigned to either the 3.5-mm (n = 180) or 4.8-mm (n = 177) group. Two patients randomized to the 4.8-mm group did not undergo the operative procedure and were excluded from the analysis. The primary outcome measures included the rate of GI hemorrhage, anastomotic stricture, and wound infection.
The 2 groups were similar with regard to the demographics and baseline body mass index (47 versus 48 kg/m(2)). The operative time, blood loss, and postoperative hematocrit on day 2 were similar between the 2 groups. No significant differences were seen in the overall rate of intraoperative GI bleeding or postoperative GI bleeding from all sources (3.3% for 3.5 mm versus 6.3% for 4.8 mm, P >.05); however, a trend was seen toward a lower rate of postoperative GI bleeding from the gastric pouch or gastrojejunostomy (.5% for 3.5 mm versus 3.4% for 4.8 mm, P = .06). The rate of anastomotic stricture was significantly lower in the 3.5-mm group (3.9% versus 16.0%, P <.01). No significant differences were seen in rate of wound infection between the 2 groups. Other morbidities for the entire study cohort included leaks (1.1%), pulmonary embolism (.6%), gastrointestinal obstruction (1.4%), and reoperation (3.4%). The overall in-hospital mortality rate was .3%, and the 30-day mortality rate was .8%.
In the present prospective, randomized trial, using a circular stapler with a shorter staple height (3.5 mm) during construction of the gastrojejunostomy, significantly reduced the rate of postoperative anastomotic stricture, with a trend toward a lower rate of GI bleeding from the gastrojejunostomy.
在腹腔镜胃旁路手术中，胃肠（GI）出血和吻合口狭窄是常见的并发症。使用较短钉高的吻合器可以降低术后 GI 出血的发生率。本研究的目的是评估使用 25mm 圆形吻合器进行胃旁路术，吻合胃空肠时使用 3.5-与 4.8mm 钉高的患者的结果。
2007 年 1 月至 2009 年 2 月，357 例患者接受腹腔镜胃旁路术，使用圆形吻合器构建胃肠吻合术，随机分为 3.5mm（n=180）或 4.8mm（n=177）组。2 名随机分配到 4.8mm 组的患者未进行手术，被排除在分析之外。主要观察指标包括 GI 出血、吻合口狭窄和伤口感染的发生率。
两组在人口统计学和基线体重指数（47 与 48kg/m2）方面相似。两组的手术时间、出血量和术后第 2 天的血细胞比容相似。两组术中 GI 出血或术后所有来源的 GI 出血的总发生率无显著差异（3.3%为 3.5mm，6.3%为 4.8mm，P>.05）；然而，术后来自胃袋或胃肠吻合口的 GI 出血发生率呈下降趋势（0.5%为 3.5mm，3.4%为 4.8mm，P=.06）。3.5mm 组吻合口狭窄发生率明显较低（3.9%比 16.0%，P<.01）。两组间伤口感染发生率无显著差异。整个研究队列的其他并发症包括漏（1.1%）、肺栓塞（0.6%）、胃肠道梗阻（1.4%）和再次手术（3.4%）。总住院死亡率为 0.3%，30 天死亡率为 0.8%。
在本前瞻性、随机试验中，在构建胃肠吻合术时使用较短钉高（3.5mm）的圆形吻合器，显著降低了术后吻合口狭窄的发生率，胃肠吻合口出血的发生率呈下降趋势。
