New York Medical College, Vahalla, NY, USA.
New York Langone Health-Brooklyn, Brooklyn, NY, USA.
Surg Endosc. 2021 Dec;35(12):6489-6496. doi: 10.1007/s00464-020-08142-x. Epub 2020 Nov 6.
There are several ways to perform the gastrojejunostomy (GJ) anastomosis in laparoscopic Roux-en-Y gastric bypass (LRYGB). Surgeons typically use a variation of three techniques: Hand-sewn anastomosis (HSA), Linear stapled (LS) and Circular stapled anastomosis (CSA). The purpose of this literature review is to determine which of the GJ techniques, if any, is superior and results in the least amount of postoperative complications, with a specific focus on rates of marginal ulcers, postoperative bleeding, and strictures.
PubMed, Embase, and Cochrane electronic databases were consulted for studies on LRYGB procedures utilizing a GJ anastomosis, from January 1, 2015 to December 31, 2019. Cochrane and PRISMA screening methods were used to select the studies.
Eleven studies published between 2015 and 2019 were selected and included 135,899 patients that underwent LRYGB with a GJ anastomosis. Sample sizes ranged from 114 to 49,331 patients. Four studies reported that CSA had statistically significant higher rates of marginal ulcers when compared to HSA and LS techniques. Three studies concluded that CSA had statistically significant higher rates of postoperative bleeding when compared to HSA and LS. Five studies observed that CSA had statistically significant higher rates of strictures when compared to HSA and LS techniques. There was no consensus whether HSA or LS was superior in terms of reduced postoperative complications.
This study revealed statistically significant increases in rates of postoperative bleeding, marginal ulcer, and strictures with the use of mechanical circular staplers at the GJ anastomosis in LRYGB. Based on our results, avoiding the use of mechanical circular staplers can result in fewer postoperative complications. Nevertheless, there are limitations to retrospective studies which may influence the results and therefore a randomized controlled trial directly comparing HSA, CSA, and LS should be performed to truly determine which technique is superior.
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）中，胃空肠吻合术（GJ）有几种方法。外科医生通常使用三种技术的变体：手工吻合（HSA）、线性吻合（LS）和圆形吻合（CSA）。本文综述的目的是确定哪种 GJ 技术（如果有的话）更优越，导致术后并发症最少，特别关注边缘溃疡、术后出血和狭窄的发生率。
从 2015 年 1 月 1 日至 2019 年 12 月 31 日，检索了PubMed、Embase 和 Cochrane 电子数据库中关于 LRYGB 手术中使用 GJ 吻合术的研究。采用 Cochrane 和 PRISMA 筛选方法选择研究。
2015 年至 2019 年期间发表的 11 项研究入选，共纳入 135899 例接受 LRYGB 并进行 GJ 吻合术的患者。样本量从 114 例到 49331 例不等。四项研究报告称，与 HSA 和 LS 技术相比，CSA 具有统计学意义上更高的边缘溃疡发生率。三项研究得出结论，与 HSA 和 LS 相比，CSA 具有统计学意义上更高的术后出血发生率。五项研究观察到 CSA 在 GJ 吻合术时与 HSA 和 LS 技术相比，具有统计学意义上更高的狭窄发生率。关于 HSA 或 LS 在减少术后并发症方面是否更优越，尚无共识。
本研究表明，在 LRYGB 中，GJ 吻合术使用机械圆形吻合器会导致术后出血、边缘溃疡和狭窄的发生率增加。根据我们的结果，避免使用机械圆形吻合器可减少术后并发症。然而，回顾性研究存在局限性，可能会影响结果，因此应该进行直接比较 HSA、CSA 和 LS 的随机对照试验，以真正确定哪种技术更优越。
