Stumpf Oliver, Lange Volker, Rosenthal Anke, Lefering Rolf, Paasch Christoph
Center of Obesity and Metabolic Surgery, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Berlin, Germany.
Obesity Outpatient Clinic, Bismarckstraße 101, 10625, Berlin, Germany.
Ann Med Surg (Lond). 2022 May 16;78:103787. doi: 10.1016/j.amsu.2022.103787. eCollection 2022 Jun.
In bariatric surgery the laparoscopic Roux-en-Y gastric bypass (LRYGB) has been proven to be a safe and effective approach. Currently the optimal size of the linear-stapled gastrojejunostomy (GJ) and its impact on weight loss are not known due to a lack of clinical trials on that topic. We aimed to provide evidence on the impact of the GJ size in terms of gastric bypass weight loss.
Patients who underwent LRYGB due to morbid obesity were retrospectively analyzed from January 2013 to January 2016. While the procedure was completely standardized, one surgeon continued using the 45 mm sized linear stapler to perform GJ while the other switched to using a 30 mm cartridge.
277 patients were female (78%) and 77 males. The average age was 41.7 ± 12.3 years. In 118 cases a 30 mm sized GJ was conducted. 236 individuals received a 45 mm sized GJ. In terms of gender, age, length of biliary and alimentary limb both groups were homogenous. Individuals with a 30 mm sized GJ had a statistical significant lower rate of therapy failure (Excess weight loss <25%, 25-49%, ≥50% after 3 years, P value χ for trend <0.035).The excess weight loss did not significant differ between both groups.
A 30 mm sized GJ may lead to a lower rate of therapy failure in comparison to a 45 mm sized GJ following laparoscopic Roux-en-Y gastric bypass. Prospective trials are mandatory to confirm our findings.
在减肥手术中，腹腔镜Roux-en-Y胃旁路术（LRYGB）已被证明是一种安全有效的方法。目前，由于缺乏关于该主题的临床试验，线性吻合器胃空肠吻合术（GJ）的最佳尺寸及其对体重减轻的影响尚不清楚。我们旨在提供关于GJ尺寸对胃旁路术后体重减轻影响的证据。
对2013年1月至2016年1月因病态肥胖接受LRYGB手术的患者进行回顾性分析。虽然手术完全标准化，但一名外科医生继续使用45毫米尺寸的线性吻合器进行GJ，而另一名外科医生则改用30毫米的钉仓。
277例患者为女性（78%），77例为男性。平均年龄为41.7±12.3岁。118例进行了30毫米尺寸的GJ。236例接受了45毫米尺寸的GJ。在性别、年龄、胆胰支和 alimentary 支长度方面，两组均具有同质性。30毫米尺寸GJ的患者治疗失败率（3年后超重减轻<25%、25-49%、≥50%）在统计学上显著较低（趋势χ检验P值<0.035）。两组之间的超重减轻没有显著差异。
与腹腔镜Roux-en-Y胃旁路术后45毫米尺寸的GJ相比，30毫米尺寸的GJ可能导致较低的治疗失败率。必须进行前瞻性试验以证实我们的发现。
