Major Piotr, Janik Michał R, Wysocki Michał, Walędziak Maciej, Pędziwiatr Michał, Kowalewski Piotr K, Małczak Piotr, Paśnik Krzysztof, Budzyński Andrzej
2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland.
Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Krakow, Poland.
Wideochir Inne Tech Maloinwazyjne. 2017 Jun;12(2):140-146. doi: 10.5114/wiitm.2017.66868. Epub 2017 Mar 29.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common, well-established procedure, but no consensus regarding selection of the gastrojejunostomy (GJ) technique has been reached, and standardization of this precise technique is far from being achieved.
To compare circular-stapled and linear-stapled GJ in LRYGB in terms of operative time and postoperative complications.
This retrospective case-control study compared the perioperative and postoperative outcomes of LRYGB with a circular-stapled (LRYGB-CS) versus linear-stapled (LRYGB-LS) gastrojejunostomy. All patients, operated on in two academic referral care centers for bariatric surgery, were enrolled from April 2013 to June 2016. 457 patients were included (255 and 202 respectively in the LRYGB-CS and LRYGB-LS groups). After matching the groups for age, sex, body mass index, arterial hypertension, and presence of type 2 diabetes in a 1 : 1 ratio, 99 patients were enrolled in each.
The total operative time was longer in the LRYGB-LS group (140 vs. 85 min, p < 0.001). The postoperative hemorrhage and wound infection rates were lower in the LRYGB-LS group (2.1% vs. 10.3%, p = 0.021, and 1.0% vs. 9.3%, p = 0.011). The readmission rates were comparable (8.2% vs. 6.1%, p = 0.593). There was no significant difference in the incidence of gastrojejunostomy leakage, stricture, port-site hernia, or marginal ulcer.
Both anastomosis types for LRYGB are safe and have low and comparable risks of postoperative complications. After LRYGB-CS, postoperative bleeding and wound infections are slightly more frequent; however, the operative time is shorter.
腹腔镜Roux-en-Y胃旁路术（LRYGB）是一种常见且成熟的手术，但在胃空肠吻合术（GJ）技术的选择上尚未达成共识，这种精确技术的标准化远未实现。
比较LRYGB中圆形吻合器和线性吻合器进行胃空肠吻合术在手术时间和术后并发症方面的差异。
这项回顾性病例对照研究比较了采用圆形吻合器（LRYGB-CS）与线性吻合器（LRYGB-LS）进行胃空肠吻合术的LRYGB患者围手术期和术后的结果。2013年4月至2016年6月期间，纳入了在两个学术性肥胖症手术转诊护理中心接受手术的所有患者。共纳入457例患者（LRYGB-CS组和LRYGB-LS组分别为255例和202例）。在按1:1比例对两组患者的年龄、性别、体重指数、动脉高血压和2型糖尿病的存在情况进行匹配后，每组纳入99例患者。
LRYGB-LS组的总手术时间更长（140分钟对85分钟，p<0.001）。LRYGB-LS组的术后出血和伤口感染率较低（分别为2.1%对10.3%，p=0.021，以及1.0%对9.3%，p=0.011）。再入院率相当（8.2%对6.1%，p=0.593）。胃空肠吻合口漏、狭窄、切口疝或边缘溃疡的发生率无显著差异。
LRYGB的两种吻合方式都是安全的，术后并发症风险低且相当。LRYGB-CS术后，术后出血和伤口感染稍微更常见；然而，手术时间更短。
