Hôpital Civil de Colmar, 39, Avenue de la Liberté, 68240, Colmar Cedex, France,
Surg Endosc. 2013 Oct;27(10):3846-51. doi: 10.1007/s00464-013-2993-5. Epub 2013 May 31.
This study aimed primarily to evaluate the safety of digestive running suture (in gastrojejunal and antecolic jejunojejunal anastomosis closure) using unidirectional absorbable barbed suture (V-Loc 180) in laparoscopic Roux-en-Y gastric bypass (LRYGB) and secondarily to assess the efficacy of V-Loc 180 in reducing operative time.
A prospective cohort study of 315 consecutive patients who underwent LRYGB was performed between October 2009 and October 2012 using an identical procedure technique. For the first 76 patients, a multifilament absorbable suture was used to assess the gastrojejunal anastomosis and the antecolic jejunal suture. For the following 239 patients, a unidirectional barbed monofilament suture was used. Data including operative time, time required for gastric pouch creation, time spent in both anastomoses constructions, conversion rate, and complications were prospectively recorded.
The postoperative complications did not differ significantly between the two groups. Early complications were observed for 1 patient (1.3%) in the multifilament group and for 14 patients (5.8%) in the barbed procedure group (p > 0.05). Late complications were observed for 1 patient (1.3%) in the multifilament group and for 5 patients (2%) in the barbed procedure group (p > 0.05). A shortened operative time was achieved in the barbed suture group. The mean operative time was 74.3 ± 15.3 min in the Vicryl group versus 62.7 ± 15.5 min in the V-Loc group (p < 0.05). The mean operative time required to fashion the gastrojejunal anastomosis was 21.3 ± 6.3 min in the Vicryl group versus 17.4 ± 5.1 min in the V-Loc group (p < 0.05). The mean operative time required to fashion the jejunojejunal anastomosis was 21.4 ± 4.9 min in the Vicryl group versus 15.2 ± 5.5 min in the V-Loc group (p < 0.05).
The authors' experience has demonstrated that the use of interlocked V-Loc suture during LRYGB anastomosis appears to be safe and efficient. The findings show a shortened total operative time in terms of single gastrojejunal or jejunojejunal anastomosis time. No statistically significant differences in early or late postoperative complications were observed between the V-Loc and multifilament absorbable suture patients.
本研究旨在评估在腹腔镜 Roux-en-Y 胃旁路术（LRYGB）中使用单向可吸收带刺缝线（V-Loc 180）进行消化性连续缝合（胃空肠和前结肠空肠吻合口闭合）的安全性，并次要评估 V-Loc 180 降低手术时间的效果。
2009 年 10 月至 2012 年 10 月，对 315 例连续接受 LRYGB 治疗的患者进行了前瞻性队列研究，采用相同的手术技术。在前 76 例患者中，使用多股可吸收缝线评估胃空肠吻合口和前结肠空肠吻合口。在后 239 例患者中，使用单向带刺单股缝线。前瞻性记录手术时间、胃袋制作时间、两个吻合口构建时间、转化率和并发症等数据。
两组患者术后并发症无显著差异。多股缝线组有 1 例（1.3%）发生早期并发症，带刺缝线组有 14 例（5.8%）发生（p>0.05）。多股缝线组有 1 例（1.3%）发生晚期并发症，带刺缝线组有 5 例（2%）发生（p>0.05）。带刺缝线组手术时间缩短。Vicryl 组的平均手术时间为 74.3±15.3 分钟，V-Loc 组为 62.7±15.5 分钟（p<0.05）。Vicryl 组胃空肠吻合口成形的平均手术时间为 21.3±6.3 分钟，V-Loc 组为 17.4±5.1 分钟（p<0.05）。Vicryl 组空肠空肠吻合口成形的平均手术时间为 21.4±4.9 分钟，V-Loc 组为 15.2±5.5 分钟（p<0.05）。
作者的经验表明，在 LRYGB 吻合术中使用互锁 V-Loc 缝线似乎是安全有效的。研究结果显示，在单个胃空肠或空肠空肠吻合口时间方面，总手术时间缩短。V-Loc 和多股可吸收缝线患者的早期和晚期术后并发症无统计学差异。
