Department of Surgery, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, 1107 2020, Beirut, Lebanon.
Biostatistics Unit, Clinical Research Institute, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Surg Endosc. 2019 Nov;33(11):3629-3634. doi: 10.1007/s00464-018-06650-5. Epub 2019 Jan 31.
Intraoperative endoscopy (IOE) has been proposed to decrease serious complications following bariatric surgeries such as leaks, bleeding, and stenosis. Such complications can lead to sepsis and eventually can be fatal. We aim to compare major postoperative complications in patients with and without IOE.
Data from the American College of Surgeons National Surgical Quality Improvement Program database years 2011 till 2016 were used to identify laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) patients. We compared outcomes of IOE and non-IOE using bivariate and multivariate analysis. Thirty-day outcomes included sepsis, organ space infection, unplanned reoperations, unplanned readmissions, prolonged hospital stay, bleeding, and mortality.
Out of 62,805 cases of LSG and 50,047 cases of LRYGB, 17.9%, and 19.7% had IOE, respectively. Endoscopy-assisted LSG was associated with a decrease in sepsis [0.37% vs. 0.21%, adjusted odds ratio (AOR) = 0.55 (0.36, 0.84)], unplanned reoperation [0.58% vs. 0.38%, AOR = 0.61 (0.44, 0.85)], prolonged hospital stay [14.9% vs. 14.0%, AOR = 0.87 (0.82, 0.92)], and composite complications [1.43% vs. 1.17%, AOR = 0.78 (0.65, 0.94)]. Outcomes after LRYGB were similar in both groups, except for decreased prolonged hospital stay with IOE [22.4% vs. 20.6%, AOR = 0.89 (0.84, 0.94)].
IOE is generally underutilized in baraitric procedures. IOE is associated with decreased risk of postoperative complications particularly sepsis, unplanned reoperations, prolonged hospital stay, and composite complications after LSG; and hospital stay after LRYGB. Large multicenter prospective studies are needed to explore the benefits of IOE in bariatric surgery, particularly the intermediate or long-term benefits.
术中内镜检查（IOE）已被提议用于减少减重手术后的严重并发症，如漏、出血和狭窄。这些并发症可导致脓毒症，最终可能致命。我们旨在比较有和没有 IOE 的患者的主要术后并发症。
使用美国外科医师学院国家手术质量改进计划数据库 2011 年至 2016 年的数据，确定腹腔镜袖状胃切除术（LSG）和腹腔镜 Roux-en-Y 胃旁路术（LRYGB）患者。我们使用双变量和多变量分析比较 IOE 和非 IOE 的结果。30 天的结果包括脓毒症、器官间隙感染、非计划再次手术、非计划再入院、住院时间延长、出血和死亡率。
在 62805 例 LSG 和 50047 例 LRYGB 中，分别有 17.9%和 19.7%的患者进行了 IOE。内镜辅助 LSG 与脓毒症的减少相关[0.37%比 0.21%，调整后的优势比（AOR）=0.55（0.36，0.84）]、非计划再次手术[0.58%比 0.38%，AOR=0.61（0.44，0.85）]、住院时间延长[14.9%比 14.0%，AOR=0.87（0.82，0.92）]和复合并发症[1.43%比 1.17%，AOR=0.78（0.65，0.94）]。两组 LRYGB 术后结果相似，除 IOE 组住院时间延长减少[22.4%比 20.6%，AOR=0.89（0.84，0.94）]外。
IOE 在减重手术中普遍未被充分利用。IOE 与术后并发症风险降低相关，特别是 LSG 后的脓毒症、非计划再次手术、住院时间延长和复合并发症；以及 LRYGB 后的住院时间。需要进行大型多中心前瞻性研究，以探讨 IOE 在减重手术中的益处，特别是中短期益处。
