Sahloul Mohamed, Kapoulas Spyridon, Giet Leeying, Ludwig Christian, Mahawar Kamal, Dennison Ashley R, Singhal Rishi
Department of Hepatopancreatic and Biliary Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK.
Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
J Minim Access Surg. 2022 Jan-Mar;18(1):90-96. doi: 10.4103/jmas.JMAS_222_20.
Numerous techniques have been described for fashioning gastrojejunostomy (GJ) in a Roux-en-Y gastric bypass. These include hand-sewn anastomosis (HSA) and mechanical anastomosis; the latter includes circular stapled anastomosis (CSA) or manual linear stapled anastomosis (mLSA). More recently, this list also includes powered linear stapled anastomosis (pLSA). The aim of this study was to analyse if addition of power to stapling would improve the integrity of GJ anastomosis in ex vivo porcine models.
The present study included five groups - mLSA1, mLSA2, HSA, CSA, and pLSA. Sequential infusions of methylene blue-coloured saline were performed into the GJ models. Pressure readings were recorded till the point of leak denoting burst pressure (BP). Total volume (TV) and site of leak were recorded. Compliance was calculated from the equation ΔTV/ΔBP.
Differences in pouch and intestinal thickness were not statistically significant between the models. BPs were higher in the mechanical anastomosis groups, i.e., pLSA 21 ± 9.85 mmHg, CSA 20.33 ± 5.78 mmHg, mLSA1 18 ± 4.69 mmHg and mLSA2 11 ± 2.94 mmHg, when compared to HSA 9.67 ± 3.79 mm Hg, which was found to be statistically significant (Kruskal-Wallis test, P = 0.03). Overall, the highest BP was recorded for powered stapling followed by circular, and then, linear stapling; however, this difference was not statistically significant (P = 0.86). There was no statistically significant difference among groups with regard to compliance (Kruskal-Wallis test, P = 0.082).
Despite the limited number of samples, mechanical anastomosis showed a statistically higher BP when compared to HSA, suggesting better anastomotic integrity. The pLSA group showed promising results with the highest BP recorded among all groups; however, this did not reach statistical significance.
在Roux-en-Y胃旁路术中，已经描述了多种构建胃空肠吻合术（GJ）的技术。这些技术包括手工缝合吻合术（HSA）和机械吻合术；后者包括圆形吻合器吻合术（CSA）或手动线性吻合器吻合术（mLSA）。最近，这个列表中还增加了动力线性吻合器吻合术（pLSA）。本研究的目的是分析在体外猪模型中，使用动力吻合器是否能提高GJ吻合的完整性。
本研究包括五组——mLSA1、mLSA2、HSA、CSA和pLSA。向GJ模型中依次注入亚甲蓝染色的盐水。记录压力读数，直至出现泄漏点，即破裂压力（BP）。记录总体积（TV）和泄漏部位。根据公式ΔTV/ΔBP计算顺应性。
各模型之间的胃囊和肠壁厚度差异无统计学意义。与HSA组（9.67±3.79mmHg）相比，机械吻合术组的BP更高，即pLSA组为21±9.85mmHg，CSA组为20.33±5.78mmHg，mLSA1组为18±4.69mmHg，mLSA2组为11±2.94mmHg，差异具有统计学意义（Kruskal-Wallis检验，P = 0.03）。总体而言，动力吻合术的BP最高，其次是圆形吻合术，然后是线性吻合术；然而，这种差异无统计学意义（P = 0.86）。各组之间的顺应性差异无统计学意义（Kruskal-Wallis检验，P = 0.082）。
尽管样本数量有限，但与HSA相比，机械吻合术的BP在统计学上更高，表明吻合完整性更好。pLSA组的结果令人鼓舞，在所有组中BP最高；然而，这并未达到统计学意义。
