Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Surg Obes Relat Dis. 2020 Aug;16(8):1005-1010. doi: 10.1016/j.soard.2020.04.013. Epub 2020 Apr 21.
Anastomotic leak at the gastrojejunostomy in Roux-en-Y gastric bypass is a rare, but serious, complication. Little has been published on leaks at other sites.
To assess incidence, risk factors, treatment, and outcome of small bowel leaks at the enteroenteral anastomosis (EA) and undiagnosed iatrogenic small bowel perforations in primary Roux-en-Y gastric bypass.
Nationwide cohort, Sweden.
All leaks within 30 days in 41,342 patients (age 40.8 [standard deviation 11.1] yr, females 68%, and body mass index 42.4 [standard deviation 5.4] kg/m) between 2007 and 2014 in the Scandinavian Obesity Surgery Registry were assessed. Register data and outcomes were verified by reviewing patient charts. Logistic regression estimated odds ratios (OR) and 95% confidence intervals for significant risk factors.
The incidence of small bowel leaks was .3%. Iatrogenic perforations were diagnosed earlier than EA leaks, 3.6 versus 6.5 days after surgery (P = .02). EA leaks were seen in 75 patients (.2%), with surgery at a low-volume center (<125 cases/yr, OR 2.1 [1.0-4.1]) and prolonged operative time (≥90 min, OR 3.5 [1.1-11.0]) as risk factors. The risk of iatrogenic small bowel perforations, .1%, was tripled by prolonged operative time (OR 3.4 [1.2-9.4]). Surgical reintervention was required in 97% of leaks, repairing the defect and draining the abdominal cavity in most cases. A third of the patients required intensive care, of which 5% developed multiorgan failure and 1% died.
Small bowel leaks, seen in .3%, were associated to prolonged operative time, and surgery at a low-volume center for EA leaks. Surgical reintervention was common, while mortality was low.
Roux-en-Y 胃旁路术吻合口漏是一种罕见但严重的并发症。关于其他部位漏的报道很少。
评估原发性 Roux-en-Y 胃旁路术中小肠肠肠吻合口（EA）漏和未诊断的医源性小肠穿孔的发生率、危险因素、治疗和结果。
全国性队列，瑞典。
在 2007 年至 2014 年期间， Scandinavian Obesity Surgery Registry 中评估了 41342 例（年龄 40.8 [标准差 11.1]岁，女性占 68%，体重指数 42.4 [标准差 5.4]kg/m）患者术后 30 天内所有漏口。通过查阅患者病历，验证登记数据和结局。Logistic 回归估计了显著危险因素的比值比（OR）和 95%置信区间。
小肠漏的发生率为 0.3%。医源性穿孔的诊断时间早于 EA 漏，分别为术后 3.6 和 6.5 天（P =.02）。EA 漏发生在 75 例患者中（0.2%），手术在低容量中心（<125 例/年，OR 2.1 [1.0-4.1]）和手术时间延长（≥90 分钟，OR 3.5 [1.1-11.0]）是危险因素。医源性小肠穿孔的风险为 0.1%，手术时间延长使风险增加三倍（OR 3.4 [1.2-9.4]）。97%的漏口需要再次手术，大多数情况下修复缺陷并引流腹腔。三分之一的患者需要重症监护，其中 5%发生多器官功能衰竭，1%死亡。
EA 漏口发生率为 0.2%，与手术时间延长和低容量中心手术相关。再次手术很常见，死亡率很低。
