腹腔镜 Roux-en-Y 胃旁路术后早期需要内镜干预的胃空肠吻合口狭窄的发生率和危险因素：MBSAQIP 分析。

Incidence and risk factors for early gastrojejunostomy anastomotic stricture requiring endoscopic intervention following laparoscopic Roux-en-Y gastric bypass: a MBSAQIP analysis.

机构信息

Department of Surgery, Section of Minimally Invasive and Bariatric Surgery, David Geffen School of Medicine at University of California, Box 956904, 72-239 CHS, Los Angeles, CA, 90095, USA.

UCLA Center for Obesity and METabolic Health (COMET), Los Angeles, CA, USA.

出版信息

Surg Endosc. 2022 Jun;36(6):3833-3842. doi: 10.1007/s00464-021-08700-x. Epub 2021 Sep 1.

DOI:10.1007/s00464-021-08700-x

PMID:34471978

Abstract

BACKGROUND

Gastrojejunostomy (GJ) stricture is one of the most commonly recognized complications following laparoscopic Roux-en-Y gastric bypass (LRYGB). The risks involving the formation of early GJ stomal stenosis are largely unknown. The aims of this study are to evaluate the rate and risk factors associated with GJ stricture in patients requiring esophagogastroduodenoscopy (EGD) within 30 days after LRYGB.

METHODS

This is a retrospective study of patients who underwent EGD for GJ stricture following LRYGB. Data were retrieved from MBSAQIP database from 2015 to 2018. Descriptive, bivariate, and logistic regression analyses were performed. Those who had reoperation, readmission, and intervention for other indications rather than GJ stricture were excluded from the risk factor analysis.

RESULTS

760,076 patients underwent bariatric surgery. Of these, 184,660 (24.3%) underwent LRYGB and 875 had GJ stricture within 30 days postoperatively. The overall incidence of early GJ stricture after LRYGB was 4.7 per 1000 person-years. The incidence decreased from 6.2 to 3.4 per 1000 person-years during the 4-year period. 85% of patients with GJ stricture required therapeutic intervention. Median (IQR) day to the first endoscopic intervention was 25 (21-28) days. The overall 30-day readmission rate was 40%. 30-day reoperation rate due to GJ stricture was 5.6%. No 30-day mortality occurred. Factors independently associated with an increased risk for early GJ stricture include concurrent hiatal hernia repair (Adjusted Odds Ratio-AOR 1.8, 95% CI 1.5-2.2), revision case (AOR 1.4, 95% CI 1.1-1.6), African American (AOR 1.4, 95% CI 1.2-1.7), gastroesophageal reflux disease-GERD (AOR 1.4, 95% CI 1.2-1.5), drain placement (AOR 1.3, 95% CI1.1-1.4), and routine postoperative swallow study (AOR 1.3, 95% CI 1.1-1.50).

CONCLUSION

The incidence of early GJ stricture following LRYGB decreased at MBSAQIP-accredited centers over the review period. Patients having additional manipulation at or around GJ were at risk of developing early GJ stricture after LRYGB.

摘要

背景

胃空肠吻合口（GJ）狭窄是腹腔镜 Roux-en-Y 胃旁路术（LRYGB）后最常见的公认并发症之一。形成早期 GJ 吻合口狭窄的风险在很大程度上尚不清楚。本研究的目的是评估在 LRYGB 后 30 天内行食管胃十二指肠镜检查（EGD）的患者中 GJ 狭窄的发生率和相关风险因素。

方法

这是一项对接受 LRYGB 后因 GJ 狭窄而行 EGD 的患者进行的回顾性研究。数据来自 2015 年至 2018 年 MBSAQIP 数据库。进行描述性、双变量和逻辑回归分析。排除因 GJ 狭窄以外的其他指征（如再手术、再入院和介入治疗）而再次手术、再次入院和介入治疗的患者进行风险因素分析。

结果

760076 例患者接受了减重手术。其中 184660 例（24.3%）接受了 LRYGB，875 例在术后 30 天内发生 GJ 狭窄。LRYGB 后早期 GJ 狭窄的总体发生率为每 1000 人年 4.7 例。在 4 年期间，该发生率从 6.2 降至 3.4 每 1000 人年。85%的 GJ 狭窄患者需要治疗干预。首次内镜干预的中位数（IQR）时间为 25（21-28）天。总的 30 天再入院率为 40%。由于 GJ 狭窄导致的 30 天再手术率为 5.6%。无 30 天死亡发生。与早期 GJ 狭窄风险增加相关的独立因素包括同时行食管裂孔疝修补术（校正优势比-AOR 1.8，95%可信区间 1.5-2.2）、翻修病例（AOR 1.4，95%可信区间 1.1-1.6）、非裔美国人（AOR 1.4，95%可信区间 1.2-1.7）、胃食管反流病-GERD（AOR 1.4，95%可信区间 1.2-1.5）、引流管放置（AOR 1.3，95%可信区间 1.1-1.4）和常规术后吞咽研究（AOR 1.3，95%可信区间 1.1-1.50）。