Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Fort Lewis, WA 98431, USA.
Department of Surgery, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Fort Lewis, WA 98431, USA.
Am J Surg. 2014 May;207(5):739-41; discussion 741-2. doi: 10.1016/j.amjsurg.2013.12.018. Epub 2014 Mar 12.
Internal hernias (IHs) occur more frequently in laparoscopic gastric bypass (LGB) surgery than in the classic open procedure. The incidence of small bowel obstruction after LGB ranges from 1.8% and 9.7%. Some have theorized that this occurs because of decreased adhesion formation.
The mesenteric irritation technique is performed after closure of the jejunojejunal mesenteric defect with a running 2-0 silk suture. A sponge is then rubbed against the closed visceral peritoneal mesentery until petechiae are visualized on the surface of the mesentery.
In all, 338 LGBs were performed using the standard closure technique with an IH incidence of 5.3% (range 1.7% to 7.8%). When using the mesenteric irritation technique, 72 LGBs were performed with an IH rate of 1.4% (P = .13).
Mesenteric irritation is a novel technique performed with minimal additional time and no additional equipment. This technique may prove beneficial in reducing the incidence of IHs.
腹腔镜胃旁路术（LGB）中内疝（IHs）的发生率高于经典的开放手术。LGB 术后小肠梗阻的发生率为 1.8%至 9.7%。有人推测这是由于粘连形成减少所致。
用 2-0 丝线连续缝合关闭空肠空肠系膜缺损后，采用肠系膜刺激技术。然后用海绵摩擦封闭的内脏腹膜系膜，直到系膜表面出现瘀点。
共行 338 例 LGB，采用标准缝合技术，IH 发生率为 5.3%（1.7%至 7.8%）。当使用肠系膜刺激技术时，72 例 LGB 的 IH 发生率为 1.4%（P=.13）。
肠系膜刺激是一种新的技术，只需额外增加很少的时间，不需要额外的设备。该技术可能有助于降低 IHs 的发生率。
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