Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
Ann Surg. 2020 Jul;272(1):125-129. doi: 10.1097/SLA.0000000000003163.
To evaluate whether pregnancy is associated with increased risk for small bowel obstruction after laparoscopic gastric bypass surgery.
Small bowel obstruction is a common and feared long-term complication to laparoscopic gastric bypass surgery that may be more common during pregnancy. It is unclear if the risk truly increases during pregnancy.
Women, 18 to 55 years, operated with a primary laparoscopic gastric bypass procedure from 2010 until 2015 were identified through the Scandinavian Obesity Surgery Registry (n = 25,853). Through record-linkage to the Medical Birth Registry, the National Patient Registry, and review of hospital charts, information on pregnancy periods and outcome were obtained. The main outcome was operation due to small bowel obstruction after the laparoscopic gastric bypass procedure.
Pregnancy was associated with increased risk for small bowel obstruction following laparoscopic gastric bypass surgery (incidence rates 46.5, 95% CI 38.0-56.9/1000 person-years, vs 20.9 95% CI 19.9-22.0; adjusted-HR 1.72, 95% CI 1.39-2.12, P < 0.001). While no excess risk was observed during the first trimester, the second (adjusted-HR 1.67, 95% CI 1.17-2.39, P = 0.005) and third (adjusted-HR 2.69, 95% CI 2.02-3.59, P < 0.001) conferred increased risk. The incidence rate of small bowel obstruction during pregnancy was 42.9 (95% CI 32.4-57.0/1000 person-years) among women for whom the mesenteric defects had been closed during the primary procedure, and 53.2 (95% CI 38.9-72.8/1000 person-years) for women in whom they had been left open.
Pregnancy is associated with increased risk for small bowel obstruction after laparoscopic gastric bypass surgery during the second and third trimesters.
评估妊娠是否会增加腹腔镜胃旁路手术后小肠梗阻的风险。
小肠梗阻是腹腔镜胃旁路手术后一种常见且令人担忧的长期并发症，在妊娠期间可能更为常见。目前尚不清楚妊娠期间风险是否真的会增加。
通过斯堪的纳维亚肥胖手术登记处（n=25853）确定 2010 年至 2015 年间接受初次腹腔镜胃旁路手术的 18 至 55 岁女性。通过与医疗出生登记处、国家患者登记处和医院病历审查进行记录链接，获得妊娠期间和结局的信息。主要结局是腹腔镜胃旁路手术后因小肠梗阻而进行的手术。
妊娠与腹腔镜胃旁路手术后小肠梗阻的风险增加相关（发生率分别为 46.5，95%CI 38.0-56.9/1000 人年，vs 20.9，95%CI 19.9-22.0；调整后 HR 1.72，95%CI 1.39-2.12，P<0.001）。虽然在孕早期没有观察到额外的风险，但在孕中期（调整后 HR 1.67，95%CI 1.17-2.39，P=0.005）和孕晚期（调整后 HR 2.69，95%CI 2.02-3.59，P<0.001）风险增加。在初次手术中关闭肠系膜缺陷的女性中，小肠梗阻的发生率为 42.9（95%CI 32.4-57.0/1000 人年），而在肠系膜缺陷未关闭的女性中，发生率为 53.2（95%CI 38.9-72.8/1000 人年）。
妊娠与腹腔镜胃旁路手术后的小肠梗阻风险增加相关，特别是在孕中期和孕晚期。
