Rausa Emanuele, Bonavina Luigi, Asti Emanuele, Gaeta Maddalena, Ricci Cristian
Department of Biomedical Sciences for Health, Division of General Surgery, IRCCS Policlinico San Donato, University of Milan Medical School, Piazza E Malan 2, San Donato Milanese, 20097, Milano, Italy.
Department of Preventive, Occupational and Community Medicine, University of Pavia, Pavia, Italy.
Obes Surg. 2016 Aug;26(8):1956-63. doi: 10.1007/s11695-016-2231-z.
Morbid obesity is a life threatening condition. Currently, surgery represents the only effective and durable therapeutic option to treat it. The first aim of the study was to estimate and compare the major surgical complications and the 30-day rate of mortality between laparoscopic and open Roux-en-Y gastric bypass (LRYGB and RYGB). The second aim was to evaluate the change in outcomes, complications, and deaths, with increased experience over the time period of the review. A random effect of the meta-analysis and meta-regression was used to evaluate surgical complications (i.e., reoperation, stenosis, bleeding, surgical site infection, fistula, internal hernia, and incisional ventral hernia) and the rate of mortality after LRYGB and RYGB over time. A search of literature from 2000 to 2014 led to the selection of 17 papers. When looking at surgical techniques separately, we observed a higher rate of mortality for open surgery (death rate 0.82 %, 95 % CI = 0.49-1.23) compared to laparoscopic surgery (death rate 0.22 %, 95 % CI = 0.09-0.40). This difference resulted highly significant when the two techniques were formally compared (p < 0.001). The improving of surgery technique resulted in a mean rate of mortality reduction of 0.069 %. Laparoscopy represents the approach of choice for bariatric surgery. Contemporary reports of LRYGB show low mortality rates and progressive decline in postoperative complications. Laparoscopic bariatric surgery requires advanced laparoscopic skills, and probably an extended learning curve is not accounted for by current mortality statistics.
病态肥胖是一种危及生命的疾病。目前，手术是治疗该病唯一有效且持久的治疗选择。本研究的首要目的是评估和比较腹腔镜与开放Roux-en-Y胃旁路术（LRYGB和RYGB）的主要手术并发症及30天死亡率。第二个目的是评估在回顾时间段内随着经验增加，手术结果、并发症及死亡情况的变化。采用荟萃分析和荟萃回归的随机效应来评估LRYGB和RYGB随时间推移的手术并发症（即再次手术、狭窄、出血、手术部位感染、瘘、内疝和切口腹疝）及死亡率。检索2000年至2014年的文献后筛选出17篇论文。单独审视手术技术时，我们观察到开放手术的死亡率较高（死亡率0.82%，95%CI = 0.49 - 1.23），而腹腔镜手术的死亡率为0.22%（95%CI = 0.09 - 0.40）。当对这两种技术进行正式比较时，这种差异具有高度显著性（p < 0.001）。手术技术的改进使平均死亡率降低了0.069%。腹腔镜检查是减肥手术的首选方法。LRYGB的当代报告显示死亡率较低且术后并发症呈逐渐下降趋势。腹腔镜减肥手术需要先进的腹腔镜技术，当前的死亡率统计可能未考虑到较长的学习曲线。
