Dang Jerry T, Deprato Andy, Verhoeff Kevin, Sun Warren, Pandey Armaan, Mocanu Valentin, Karmali Shahzeer, Switzer Noah J, Nguyen Ninh T
Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, University of Alberta Hospital, 8440 112 Street NW, Edmonton, AB, T6G 2B7, Canada.
Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Obes Surg. 2022 Jul;32(7):2357-2365. doi: 10.1007/s11695-022-06087-9. Epub 2022 May 6.
Surgical technique varies dramatically in the performance of laparoscopic Roux-en-Y gastric bypass (LRYGB) and these differences can potentially lead to variation in outcomes. The objective of this study was to characterize surgical techniques used during LRYGB.
An anonymous 44-question survey was distributed by email to all bariatric surgeons with membership in the ASMBS, SAGES, and ACS from April to June 2020. Questions were designed to evaluate surgeon demographics, experience, and variation of techniques. Only surgeons who performed LRYGB within the past year were included for analysis.
A total of 534 (18.8%) surgeons responded and the majority (97.0%) reported performing LRYGB in the past year. Surgeons were predominantly from the USA (77.8%). For preoperative work-up, 20.1% performed upper gastrointestinal series while 60.8% performed esophagogastroduodenoscopy. Limb length evaluation revealed mean Roux and biliopancreatic limb lengths of 124.1 ± 29.4 cm and 67.4 ± 32.2 cm, respectively. The gastrojejunostomy was most commonly formed using a linear stapler with handsewn closure of the common enterotomy (53.1%) and the jejunojejunostomy using a linear stapled anastomotic technique with handsewn closure of the common enterotomy (60.6%). The majority of surgeons closed the jejunojejunostomy mesenteric defect (91.1%) and one of the antecolic or retrocolic mesenteric defects (65.1%). Intraoperative leak tests were performed in 95.9% of cases. Only 22.1% of surgeons routinely performed upper gastrointestinal swallow studies postoperatively.
There are wide variations in pre- and intraoperative practice patterns for LRYGB. Further clinical trials designed to evaluate the impact of these practice pattern differences on patient outcomes are warranted.
腹腔镜Roux-en-Y胃旁路术（LRYGB）的手术技术在操作上差异很大，这些差异可能会导致结果的不同。本研究的目的是描述LRYGB手术中使用的手术技术。
2020年4月至6月，通过电子邮件向所有美国代谢与减重外科学会（ASMBS）、美国胃肠内镜外科医师学会（SAGES）和美国外科医师学会（ACS）的减重外科医生发放了一份包含44个问题的匿名调查问卷。问题旨在评估外科医生的人口统计学特征、经验和技术差异。仅纳入过去一年中进行过LRYGB手术的外科医生进行分析。
共有534名（18.8%）外科医生回复，其中大多数（97.0%）报告在过去一年中进行过LRYGB手术。外科医生主要来自美国（77.8%）。对于术前检查，20.1%的医生进行了上消化道造影，而60.8%的医生进行了食管胃十二指肠镜检查。肠袢长度评估显示，Roux袢和胆胰袢的平均长度分别为124.1±29.4厘米和67.4±32.2厘米。胃空肠吻合术最常用线性吻合器完成，同时手工缝合共同开口（53.1%）；空肠空肠吻合术采用线性吻合器吻合技术并手工缝合共同开口（60.6%）。大多数外科医生关闭了空肠空肠吻合术的肠系膜缺损（91.1%）以及结肠前或结肠后肠系膜缺损之一（65.1%）。95.9%的病例进行了术中渗漏试验。只有22.1%的外科医生常规在术后进行上消化道吞咽造影检查。
LRYGB术前和术中的操作模式存在很大差异。有必要开展进一步的临床试验，以评估这些操作模式差异对患者预后的影响。
