Inonu University, Department of Gastrointestinal Surgery, Malatya, Turkey.
Int J Surg. 2018 Oct;58:52-56. doi: 10.1016/j.ijsu.2018.09.007. Epub 2018 Sep 18.
Bleeding from the staple line is a rare but serious problem following bariatric surgery. Staple line bleeding control (SLBC) can be achieved in different ways such as the application of sutures, clips, glue or buttressing materials over the staple line. Cauterization alone is generally not preferred due to concerns about debilitating the staple line.
The aim of this study was to compare the clip and monopolar cauterization methods for SLBC in laparoscopic Roux-en-Y gastric bypass.
University hospital.
A total of 70 morbidly obese patients were randomized into two groups. Patients with previous upper gastrointestinal surgery, re-do procedures and open surgeries were excluded. Their demographic characteristics, intraoperative and postoperative outcomes were examined.
A total of 489 SLBC interventions (274 clips and 215 cauterizations) were performed after 280 stapling applications. SLBC intervention number and location, additional trocar requirement, blood loss and operation time were not different between the groups. In the clip group, two patients required monopolar cauterization when clipping failed. No intraabdominal bleeding or gastrointestinal leakage was seen in any group. Postoperative gastrointestinal hemorrhage was seen in three patients, two in the clip group and one in the cautery group. There was no difference between the groups in terms of postoperative pain score, abdominal drainage amount, hemoglobin level alteration, morbidity or length of stay.
In laparoscopic Roux-en-Y gastric bypass, monopolar cauterization for SLBC can be used instead of clipping. It appears that monopolar cautery is a safe and effective approach for SLBC in laparoscopic Roux-en-Y gastric bypass.
减重手术后吻合口出血是一种罕见但严重的问题。可以通过不同的方法来控制吻合口出血，如在吻合口上应用缝线、夹钳、胶或加固材料。由于担心削弱吻合口，单独电凝通常不被推荐。
本研究旨在比较腹腔镜 Roux-en-Y 胃旁路术中夹钳和单极电凝两种方法用于控制吻合口出血。
大学医院。
共纳入 70 例病态肥胖患者，随机分为两组。排除既往上消化道手术、再次手术和开放手术的患者。检查其人口统计学特征、术中及术后结果。
在 280 个吻合口吻合后，共进行了 489 次（夹钳 274 次，电凝 215 次）吻合口出血控制干预。两组间吻合口出血控制干预的次数和位置、是否需要额外的套管针、出血量和手术时间均无差异。在夹钳组中，有 2 例患者因夹钳失败而需要进行单极电凝。两组均未发生腹腔内出血或胃肠道漏。术后仅 3 例患者出现胃肠道出血，夹钳组 2 例，电凝组 1 例。两组在术后疼痛评分、腹部引流量、血红蛋白水平变化、发病率或住院时间方面均无差异。
在腹腔镜 Roux-en-Y 胃旁路术中，单极电凝可用于控制吻合口出血，替代夹钳。单极电凝似乎是腹腔镜 Roux-en-Y 胃旁路术控制吻合口出血的一种安全有效的方法。
