Department of Endoscopic Surgery, Haut Lévèque Hospital, Bordeaux, France.
Updates Surg. 2012 Mar;64(1):25-30. doi: 10.1007/s13304-011-0126-z. Epub 2011 Dec 14.
The laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the ideal operations in the treatment of morbid obesity. There are several variations in the operation, especially during the construction of the gastrojejunostomy (GJA). From June 2006 to September 2008, 104 consecutive obese patients underwent LRYGB. The procedure was standardized, with the exception of the construction of the GJA, which was linear-stapled in 51 patients and hand-sewn in 53 other patients. A retrospective analysis was performed to compare the procedures. The series comprised 81 women and 23 men with a median age of 44 years, and a median BMI of 46.7 kg/m(2). There was no significant difference between the two groups of patients with respect to age, gender, BMI, ASA, and previously failed bariatric surgery. There was no significant difference between the two groups with respect to mortality, conversion, early reoperation, surgical complications, GJA leakage or stricture, and bariatric results. The only significant differences between the two groups were in regards to operating time (190 min for stapled GJA vs. 160 min for hand-sewn GJA, p value 0.029) and operating supply cost (100 Euros less for hand-sewn GJA). In our experience, hand-sewn GJA during LRYGB appears to be as safe as linear-stapled GJA and provides the same bariatric results while remaining slightly less expensive.
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）是治疗病态肥胖的理想手术之一。该手术有几种变异，尤其是在胃空肠吻合术（GJA）的构建过程中。从 2006 年 6 月至 2008 年 9 月，104 例连续肥胖患者接受了 LRYGB 手术。除了 GJA 的构建，该手术过程是标准化的，51 例患者采用线性吻合器吻合，53 例患者采用手工缝合。对这两种手术方法进行了回顾性分析，以比较两种方法。该系列包括 81 名女性和 23 名男性，平均年龄为 44 岁，平均 BMI 为 46.7kg/m²。两组患者在年龄、性别、BMI、ASA 和以前的减重手术失败方面无显著差异。两组在死亡率、中转手术、早期再次手术、手术并发症、GJA 渗漏或狭窄以及减重效果方面无显著差异。两组唯一的显著差异在于手术时间（吻合器吻合 GJA 为 190 分钟，手工缝合 GJA 为 160 分钟，p 值为 0.029）和手术耗材成本（手工缝合 GJA 可节省 100 欧元）。根据我们的经验，LRYGB 术中采用手工缝合 GJA 似乎与线性吻合器吻合 GJA 一样安全，并且提供相同的减重效果，同时略微降低成本。
