Division of Bariatric Surgery, Department of Surgery, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
Surg Endosc. 2020 May;34(5):2287-2294. doi: 10.1007/s00464-019-07022-3. Epub 2019 Jul 29.
An unusually high surgical site infection (SSI) rate after Roux-en-Y gastric bypass (RYGB) was noted on routine outcomes review. Surgeon A, who had a rate of 8.9%, utilized the transoral technique (passage down esophagus into gastric pouch) for anvil insertion for the circular-stapled gastrojejunostomy. By comparison, SSI rate was 0% for Surgeon B, who inserted anvil transabdominally (direct passage into stomach via gastrotomy) and used wound protection (wound protector and plastic drape over stapler). We sought to determine if it was the technique for anvil insertion (transoral or transabdominal) or use of wound protection that could help reduce SSIs.
In mid-2017, Surgeon A added wound protection (wound protector and plastic drape over stapler) to the transoral technique to minimize oral flora wound contamination. Surgeon B made no changes. In this study, wound-related outcomes are examined, comparing patients who underwent surgery before (Group 1) versus after (Group 2) this intervention. Statistical analysis performed utilizing t tests and Chi square analysis; p < 0.05 considered significant.
Three hundred and thirty-three patients underwent RYGB. Group 1 consisted of 182 patients over 17 months; 151 patients over 13 months were in Group 2. Groups were similar in age, BMI, gender, and prevalence of diabetes. There was a decrease in SSIs between Group 1 and Group 2 (5 vs. 0, p = 0.04). 11 wound complications occurred in Group 1 (5 SSIs, 4 seromas and 2 hematomas); whereas 2 wound complications occurred in Group 2 (1 seroma and 1 hematoma); decrease from 6 to 1.3%, p = 0.03.
This study demonstrates that changing technique can lead to best outcomes. There was a dramatic reduction of wound complications and complete elimination of SSIs with a change in operative technique. The higher risk of SSI with the transoral anvil insertion when preforming a circular-stapled anastomosis can be mitigated with use of wound protection.
在常规结果审查中，注意到 Roux-en-Y 胃旁路（RYGB）后的手术部位感染（SSI）率异常高。A 医生的 SSI 率为 8.9%，他使用经口技术（经食管进入胃袋）插入吻合器进行圆形吻合。相比之下，B 医生的 SSI 率为 0%，他经腹插入吻合器（直接通过胃造口进入胃）并使用伤口保护（吻合器上的伤口保护器和塑料帘）。我们试图确定是吻合器插入技术（经口或经腹）还是使用伤口保护可以帮助降低 SSI。
2017 年年中，A 医生在经口技术中添加了伤口保护（吻合器上的伤口保护器和塑料帘），以最大程度地减少口腔菌群对伤口的污染。B 医生没有做出任何改变。在这项研究中，我们比较了接受手术前（第 1 组）和手术后（第 2 组）干预的患者的伤口相关结果。使用 t 检验和卡方分析进行统计分析；p<0.05 被认为具有统计学意义。
333 名患者接受了 RYGB。第 1 组包括 17 个月内的 182 名患者；13 个月内的 151 名患者为第 2 组。两组在年龄、BMI、性别和糖尿病患病率方面相似。第 1 组和第 2 组之间 SSI 发生率有所下降（5 例 vs. 0 例，p=0.04）。第 1 组发生 11 例伤口并发症（5 例 SSI、4 例血清肿和 2 例血肿）；第 2 组发生 2 例伤口并发症（1 例血清肿和 1 例血肿）；发生率从 6%降至 1.3%，p=0.03。
这项研究表明，改变技术可以带来最佳结果。通过改变手术技术，显著降低了伤口并发症的发生率，并完全消除了 SSI。在进行圆形吻合时，经口吻合器插入的 SSI 风险较高，使用伤口保护可以降低风险。
