Lee Sangoh, Davies Andrew R, Bahal Sameer, Cocker Daniel M, Bonanomi Gianluca, Thompson Jeremy, Efthimiou Evangelos
Bariatric and Metabolic Surgery Unit, Chelsea and Westminster Hospital NHS Trust, London, UK,
Obes Surg. 2014 Sep;24(9):1425-9. doi: 10.1007/s11695-014-1219-9.
Different gastrojejunal anastomotic (GJA) techniques have been described in laparoscopic Roux-en-Y gastric bypass (LRYGB). There is conflicting data on whether one technique is superior to the other. We aimed to compare hand-sewn (HSA), circular-stapled (CSA) and linear-stapled (LSA) anastomotic techniques in terms of stricture rates and their impact on subsequent weight loss.
A prospectively collected database was used to identify patients undergoing LRYGB surgery between March 2005 and May 2012. Anastomotic technique (HSA, CSA, LSA) was performed according to individual surgeon preference. The database recorded patient demographics, relevant comorbidities and the type of GJA performed. Serial weight measurements and percentage excess weight loss (%EWL) were available at defined follow-up intervals.
Included in the data were 426 patients, divided between HSA (n = 174, 40.8%), CSA (n = 110, 25.8%) and LSA (n = 142, 33.3%). There was no significant difference in the stricture rates (HSA n = 17, 9.72%; CSA n = 9, 8.18%; LSA n = 8, 5.63%; p = 0.4006). Weight loss was similar between the three techniques (HSA, CSA and LSA) at 3 months (40.6% ± 16.2% vs 35.92% ± 21.42% vs 48.21 % ± 14.79%; p = 0.0821), 6 months (61.48% ± 23.94% vs 58.16 % ± 27.31% vs 60.18% ± 22.26%; p = 0.2296), 12 months (72.94% ± 19.93% vs 69.72 ± 21.42% vs 66.05% ± 17.75%; p = 0.0617) and 24 months (73.29% ± 22.31% vs 68.75 % ± 24.71% vs 69.40% ± 23.10%; p = 0.7242), respectively. The stricture group lost significantly greater weight (%EWL) within the first 3 months compared to the non-stricture group (45.39% ± 16.82 % vs 39.22 % ± 21.93%; p = 0.0340); however, this difference had resolved at 6 months (61.29% ± 18.50 % vs 59.79% ± 23.03%; p = 0.8802) and 12 months (71.59 % ± 18.67 % vs 68.69 % ± 22.19 %; p = 0.5970).
There was no significant difference in the rate of strictures between the three techniques, although the linear technique appears to have the lowest requirement for post-operative dilatation. The re-intervention rate will, in part, be dictated by the threshold for endoscopy, which will vary between units. Weight loss was similar between the three anastomotic techniques. Surgeons should use techniques that they are most familiar with, as stricture and weight loss rates are not significantly different.
腹腔镜Roux-en-Y胃旁路术（LRYGB）中已有多种胃空肠吻合（GJA）技术被描述。关于哪种技术更具优势，存在相互矛盾的数据。我们旨在比较手工缝合（HSA）、圆形吻合器（CSA）和线性吻合器（LSA）吻合技术在狭窄发生率及其对后续体重减轻的影响方面的差异。
使用前瞻性收集的数据库，确定2005年3月至2012年5月期间接受LRYGB手术的患者。吻合技术（HSA、CSA、LSA）根据外科医生的个人偏好进行。数据库记录了患者的人口统计学信息、相关合并症以及所进行的GJA类型。在规定的随访间隔期可获得系列体重测量值和超重减轻百分比（%EWL）。
纳入数据的有426例患者，分为HSA组（n = 174，40.8%）、CSA组（n = 110，25.8%）和LSA组（n = 142，33.3%）。狭窄发生率无显著差异（HSA组n = 17，9.72%；CSA组n = 9，8.18%；LSA组n = 8，5.63%；p = 0.4006）。三种技术在3个月（40.6%±16.2% vs 35.92%±21.42% vs 48.21%±14.79%；p = 0.0821）、6个月（61.48%±23.94% vs 58.16%±27.31% vs 60.18%±22.26%；p = 0.2296）、12个月（72.94%±19.93% vs 69.72±21.42% vs 66.05%±17.75%；p = 0.0617）和24个月（73.29%±22.31% vs 68.75%±24.71% vs 69.40%±23.10%；p = 0.7242）时的体重减轻情况相似。与非狭窄组相比，狭窄组在最初3个月内体重减轻幅度更大（%EWL）（45.39%±16.82% vs 39.22%±21.93%；p = 0.0340）；然而，这种差异在6个月（61.29%±18.50% vs 59.79%±23.03%；p = 0.8802）和12个月（71.59%±18.67% vs 68.69%±22.19%；p = 0.5970）时已消失。
三种技术在狭窄发生率上无显著差异，尽管线性技术似乎对术后扩张的需求最低。再次干预率部分将取决于内镜检查的阈值，而各单位之间该阈值会有所不同。三种吻合技术的体重减轻情况相似。外科医生应使用他们最熟悉的技术，因为狭窄率和体重减轻率并无显著差异。
