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采用全手工缝合吻合术的三维腹腔镜Roux-en-Y胃旁路手术治疗病态肥胖症:单中心经验

Three-dimensional laparoscopic Roux-en-Y gastric bypass with totally hand-sewn anastomoses for morbid obesity. A single center experience.

作者信息

Mongelli Francesco, Regina Davide La, Garofalo Fabio, Vannelli Alberto, Giuseppe Matteo Di, FitzGerald Maurice, Marengo Michele

机构信息

MD, Department of Surgery, Ospedale Regionale di Lugano, Lugano, Switzerland. Scientific, intellectual, conception and design of the study; analysis and interpretation of data; statistics analysis; manuscript writing; final approval.

MD, Department of Surgery, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland. Analysis and interpretation of data, manuscript preparation, critical revision, final approval.

出版信息

Acta Cir Bras. 2020 Sep 7;35(8):e202000806. doi: 10.1590/s0102-865020200080000006.

Abstract

PURPOSE

To assess the impact of three-dimensional (3D) vision use on operative time (OT) in laparoscopic Roux-en-Y gastric bypass (LRYGB) with hand-sewn anastomoses.

METHODS

We analyzed a prospectively collected database of patients who underwent LRYGB. We included all patients operated on with either 2D or 3D vision. Demographics and clinical characteristics, operative time, hospital stay and 30-day postoperative complications were collected for all patients and analyzed.

RESULTS

During the study time, out of 143 patients who underwent LRYGB for morbid obesity, 111 were considered eligible. Seventy-eight patients were operated with 2D vision and 33 patients with 3D vision. Demographics and clinical characteristics were not different among groups. Mean OT was 203±51 and 167±32 minutes in the 2D and 3D groups respectively (p<0.001). Multivariate analyses showed that increasing age and BMI were independently related to prolonged OT, while 3D vision (OR 6.675, 95% CI 2.380-24.752, p<0.001) was strongly associated with shorter OT.

CONCLUSIONS

The use of 3D vision in LRYGB significantly reduced the OT, though intra- and postoperative complication rates and the length of hospital stay were not affected. Despite its limitations, our study supports the value of 3D vision laparoscopy in bariatric surgery.

摘要

目的

评估在手工缝合吻合的腹腔镜Roux-en-Y胃旁路术(LRYGB)中使用三维(3D)视觉对手术时间(OT)的影响。

方法

我们分析了一个前瞻性收集的接受LRYGB患者的数据库。我们纳入了所有使用二维或三维视觉进行手术的患者。收集并分析了所有患者的人口统计学和临床特征、手术时间、住院时间及术后30天并发症情况。

结果

在研究期间,143例因病态肥胖接受LRYGB的患者中,111例被认为符合条件。78例患者使用二维视觉进行手术,33例患者使用三维视觉进行手术。各组间人口统计学和临床特征无差异。二维组和三维组的平均手术时间分别为203±51分钟和167±32分钟(p<0.001)。多因素分析显示,年龄增长和体重指数增加与手术时间延长独立相关,而三维视觉(比值比6.675,95%可信区间2.380 - 24.752,p<0.001)与较短的手术时间密切相关。

结论

在LRYGB中使用三维视觉可显著缩短手术时间,尽管术中及术后并发症发生率和住院时间未受影响。尽管存在局限性,但我们的研究支持三维视觉腹腔镜在减肥手术中的价值。

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