腹腔镜 Roux-en-Y 胃旁路手术后一年的体重减轻与胃空肠吻合术的类型无关。

Weight loss one year after laparoscopic roux-en-Y gastric bypass is not dependent on the type of gastrojejunal anastomosis.

机构信息

Montefiore Medical Center, University Hospital of the Albert Einstein College of Medicine, New York, USA.

出版信息

Surg Endosc. 2022 Jan;36(1):787-792. doi: 10.1007/s00464-021-08288-2. Epub 2021 Feb 1.

DOI:10.1007/s00464-021-08288-2

PMID:33523274

Abstract

BACKGROUND

Laparoscopic roux-en-Y gastric bypass (LRYGB) is the gold standard weight-loss procedure. There are different techniques to perform the gastrojejunal (GJ) anastomosis, but there is no consensus as to which one is superior for weight loss. Our goal in this study was to assess one-year weight loss after LRYGB comparing the three different techniques at our tertiary care center.

METHODS

The American college of surgeons (ACS) Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP®) data for Montefiore Medical Center for years 2014-2017 were analyzed. Three surgeons were included in this study; each type of anastomosis was performed by a single surgeon. Patients were included if they underwent primary LRYGB. Patients were designated to one of three different groups depending of the type of gastrojejunal anastomosis performed: hand sewn, circular stapled, or linear stapled. One-year weight loss was assessed as primary endpoint of the study. A descriptive analysis of perioperative variables for each group was included as well.

RESULTS

A total of 1011 patients underwent primary LRYGB. 429 (42.1%) were performed with circular-stapled GJ anastomosis, 433 (42.5%) with a hand-sewn GJ anastomosis, and 149 (14.6%) linear-stapled GJ anastomosis. The median BMI was 46.08 ± 6.43, with no difference between groups (p = .405). Procedure time was 106.70 ± 28.23 min for the circular group, 108.27 ± 28.59 min for the hand-sewn group, and 115.78 ± 36.11 min for the linear group (p > 0.005). There were no significant differences in complications except for the need of postoperative transfusions (p < 0.002). There was no statistically significant difference in %EWL one year after surgery: %EWL was 58.81 ± 16.54 kg for hand sewn, 58.86 ± 14.84 kg for circular, and 59.20 ± 17.58Kg for linear. (p = .595).

CONCLUSION

There is no difference in weight loss one year after LRYGB based on the type of gastrojejunal anastomosis performed.

摘要

背景

腹腔镜 Roux-en-Y 胃旁路术（LRYGB）是减重的金标准手术。有不同的技术来进行胃肠吻合术，但哪种技术更有利于减重还没有共识。我们的目标是在我们的三级护理中心评估 LRYGB 术后一年的减重效果，比较三种不同技术。

方法

分析了 2014 年至 2017 年蒙特菲奥雷医疗中心的美国外科医师学院（ACS）代谢和减重外科认证和质量改进计划（MBSAQIP®）数据。这项研究纳入了 3 位外科医生；每位医生都采用一种吻合方式。如果患者接受了原发性 LRYGB，则将其纳入研究。根据进行的胃肠吻合术类型，将患者分为三组：手工缝合、圆形吻合器吻合或线性吻合器吻合。术后一年的体重减轻被评估为研究的主要终点。还包括了对每组围手术期变量的描述性分析。

结果

共有 1011 例患者接受了原发性 LRYGB。其中 429 例（42.1%）采用圆形吻合器进行胃肠吻合术，433 例（42.5%）采用手工缝合进行胃肠吻合术，149 例（14.6%）采用线性吻合器进行胃肠吻合术。中位 BMI 为 46.08±6.43，组间无差异（p=0.405）。圆形吻合组的手术时间为 106.70±28.23 分钟，手工缝合组为 108.27±28.59 分钟，线性吻合组为 115.78±36.11 分钟（p>0.005）。除需要术后输血外（p<0.002），并发症无显著差异。术后一年的 EWL%无统计学差异：手工缝合组为 58.81±16.54kg，圆形吻合器组为 58.86±14.84kg，线性吻合器组为 59.20±17.58kg（p=0.595）。