Edholm D, Axer S, Hedberg J, Sundbom M
1 Department of Surgical Sciences, Upper Gastrointestinal Surgery, Uppsala University, Uppsala, Sweden.
2 Department of Surgery, Torsby Hospital, Torsby, Sweden.
Scand J Surg. 2017 Sep;106(3):230-234. doi: 10.1177/1457496916673586. Epub 2016 Oct 7.
Unsatisfactory weight loss after gastric bypass or sleeve gastrectomy in super-obese patients (body mass index > 50) is a growing concern. Biliopancreatic diversion with duodenal switch results in greater weight loss, but is technically challenging to perform, especially as a laparoscopic procedure (Lap-DS). The aim of this study was to compare perioperative outcomes of Lap-DS and the corresponding open procedure (O-DS) in Sweden.
The data source was a nationwide cohort from the Scandinavian Obesity Surgery Registry and 317 biliopancreatic diversion with duodenal switch patients (mean body mass index = 56.7 ± 6.6 kg/m, 38.4 ± 10.2 years, and 57% females) were analyzed. Follow-up at 30 days was complete in 98% of patients.
The 53 Lap-DS patients were younger than the 264 patients undergoing O-DS (35.0 vs 39.1 years, p = 0.01). Operative time was 163 ± 38 min for lap-DS and 150 ± 31 min for O-DS, p = 0.01, with less bleeding in Lap-DS (94 vs 216 mL, p < 0.001). There was one conversion to open surgery. Patients undergoing Lap-DS had a shorter length of stay than O-DS, 3.3 versus 6.6 days, p = 0.02. No significant differences in overall complications within 30 days were seen (12% and 17%, respectively). Interestingly, the two leaks in Lap-DS were located at the entero-enteric anastomosis, while three out of four leaks in O-DS occurred at the top of the gastric tube.
Lap-DS can be performed by dedicated bariatric surgeons as a single-stage procedure. The use of laparoscopic approach halved the length of stay, without increasing the risk for complications significantly. Any difference in long-term weight result is pending.
超级肥胖患者（体重指数>50）在接受胃旁路手术或袖状胃切除术后体重减轻效果不理想，这一问题日益受到关注。胆胰分流十二指肠转位术能带来更多体重减轻，但技术操作具有挑战性，尤其是作为腹腔镜手术（Lap-DS）。本研究旨在比较瑞典Lap-DS与相应开放手术（O-DS）的围手术期结果。
数据来源为斯堪的纳维亚肥胖手术登记处的全国性队列，分析了317例接受胆胰分流十二指肠转位术的患者（平均体重指数=56.7±6.6kg/m，38.4±10.2岁，57%为女性）。98%的患者完成了30天的随访。
53例Lap-DS患者比264例接受O-DS的患者年轻（35.0岁对39.1岁，p=0.01）。Lap-DS的手术时间为163±38分钟，O-DS为150±31分钟，p=0.01，Lap-DS的出血量更少（94对216mL，p<0.001）。有1例转为开放手术。接受Lap-DS的患者住院时间比O-DS短，分别为3.3天和6.6天，p=0.02。30天内总体并发症无显著差异（分别为12%和17%）。有趣的是，Lap-DS的两例渗漏位于肠肠吻合处，而O-DS的四例渗漏中有三例发生在胃管顶端。
Lap-DS可由专业的减肥外科医生作为单阶段手术进行。腹腔镜手术的使用使住院时间减半，且未显著增加并发症风险。长期体重结果的任何差异尚待确定。
