Department of General Surgery A, Hillel Yaffe Medical Center, Hadera, Israel.
Obes Surg. 2011 Feb;21(2):238-43. doi: 10.1007/s11695-010-0308-7.
Anastomotic leaks, stenosis, and bleeding from the gastrojejunal anastomosis (GJA) after gastric bypass may carry high morbidity and mortality. To date, the standard operation with the circular stapler (CS) used the 25 mm with a staple height of 4.8 mm. We present herein our experience with the 3.5-mm staple height.
A total of 1,074 morbidly obese patients who underwent fully stapled laparoscopic Roux-en-Y Gastric Bypass over a period of 18 months were included in the study. Mean body mass index was 41.9 (range 28.6-70.7). Mean age was 40.9 years (range 15-74 years). Mean operating time was 73 min (range 43-210 min) and the mean length of stay was 4.2 days (range 1-25 days). The 30-day complication rate associated with GJA was prospectively analyzed.
Twenty patients (1.86%) developed postoperative bleeding. Four developed GJA bleeding (0.37%). One leak was recorded from the vertical staple line of the gastric pouch, but no leaks from the GJA were seen. Conversion to open approach was required in two patients (0.18%). Reoperation and readmission rates were 1.7% and 1.8%, respectively. Perioperative complications were observed in 34 patients (3.1%). One case of clinical GJA stenosis was detected in a mean follow-up of 10.5 months (range 5-20 months). There was no mortality in our series.
Compared to our previous experience with 4.8 mm CS, creating the GJA using a smaller staple height significantly reduced the bleeding rate and seems to be a safe technique that potentially reduces other complications related to the GJA as reported in the literature.
胃旁路术后胃空肠吻合口（GJA）的吻合口漏、狭窄和出血可能带来高发病率和死亡率。迄今为止，使用圆形吻合器（CS）的标准手术采用 25mm 直径、4.8mm 钉高。我们在此介绍采用 3.5mm 钉高的经验。
在 18 个月的时间内，共有 1074 例病态肥胖患者接受了全吻合腹腔镜 Roux-en-Y 胃旁路手术，纳入研究。平均体重指数为 41.9（范围 28.6-70.7）。平均年龄为 40.9 岁（范围 15-74 岁）。平均手术时间为 73 分钟（范围 43-210 分钟），平均住院时间为 4.2 天（范围 1-25 天）。前瞻性分析了与 GJA 相关的 30 天并发症发生率。
20 例（1.86%）患者发生术后出血。4 例发生 GJA 出血（0.37%）。1 例记录到来自胃袋垂直吻合线的漏，但未见 GJA 漏。有 2 例（0.18%）需要转为开放手术。再手术和再入院率分别为 1.7%和 1.8%。34 例患者（3.1%）发生围手术期并发症。在平均 10.5 个月（范围 5-20 个月）的随访中发现 1 例临床 GJA 狭窄。本系列无死亡病例。
与我们之前使用 4.8mm CS 的经验相比，使用较小钉高创建 GJA 显著降低了出血率，并且似乎是一种安全的技术，可能会降低文献报道的与 GJA 相关的其他并发症。
