Department of General Surgery, New York University Langone Health, 150 55th Street, Brooklyn, NY, 11220, USA.
Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Surg Endosc. 2023 Sep;37(9):7254-7263. doi: 10.1007/s00464-023-10257-w. Epub 2023 Jul 6.
New York University Langone Health has three accredited bariatric centers, with altogether ten different bariatric surgeons. This retrospective analysis compares individual surgeon techniques in laparoscopic or robotic Roux-en-Y gastric bypass (RYGB) to identify potential associations with perioperative morbidity and mortality.
All adult patients who underwent RYGB between 2017 and 2021 at NYU Langone Health campuses were evaluated via electronic medical records and MBSAQIP 30-day follow-up data. We surveyed all ten practicing bariatric surgeons to analyze the relationship between their techniques and total adverse outcomes. Bleeding, SSI, mortality, readmission, and reoperation were specifically sub-analyzed via logistic regression.
54 (7.59%) out of 711 patients who underwent laparoscopic or robotic RYGB encountered an adverse outcome. Lower adverse outcomes were observed with laparoscopic approach, creating the JJ anastomosis first, flat positioning, division of the mesentery, Covidien™ laparoscopic staplers, gold staples, unidirectional JJ anastomosis, hand-sewn common enterotomy, 100-cm Roux limb, 50-cm biliopancreatic limb, and routine EGD. Lower bleeding rates were observed with flat positioning, gold staples, hand-sewn common enterotomy, 50-cm biliopancreatic limb, and routine EGD. Lower readmission rates were observed in laparoscopic, flat positioning, Covidien™ staplers, unidirectional JJ anastomosis, and hand-sewn common enterotomy. Gold staples had lower reoperation rates. Otherwise, there was no statistically significant difference in SSI.
Certain surgical techniques in RYGB within our bariatric surgery group had significant effects on the rates of total adverse outcomes, bleeding, readmission, and reoperation. Our findings warrant further investigation into the aforementioned techniques via multivariate regression models or prospective study design.
This study was limited by the inherent nature of its retrospective and univariate statistical design. We did not account for the interaction between techniques. The sample size of surgeons was small, and follow-up of 30 days was relatively short. We did not include patient characteristics in the model or control for surgeon skill.
纽约大学朗格尼健康中心有三个经过认证的减肥中心，共有十位不同的减肥外科医生。这项回顾性分析比较了每位外科医生在腹腔镜或机器人 Roux-en-Y 胃旁路术（RYGB）中的技术，以确定与围手术期发病率和死亡率相关的潜在关联。
通过电子病历和 MBSAQIP 30 天随访数据评估了 2017 年至 2021 年间在纽约大学朗格尼健康中心校区接受 RYGB 的所有成年患者。我们调查了所有十位执业减肥外科医生，以分析他们的技术与总不良结果之间的关系。通过逻辑回归专门对出血、SSI、死亡率、再入院和再次手术进行了亚分析。
在接受腹腔镜或机器人 RYGB 的 711 名患者中，有 54 名（7.59%）发生了不良后果。腹腔镜方法、首先创建 JJ 吻合、平卧位、肠系膜分离、Covidien 腹腔镜吻合器、金钉、单向 JJ 吻合、手工缝合共同肠切开术、100cm Roux 肢体、50cm 胆胰肠吻合术和常规 EGD 观察到较低的不良结果。平卧位、金钉、手工缝合共同肠切开术、50cm 胆胰肠吻合术和常规 EGD 观察到较低的出血率。腹腔镜、平卧位、Covidien 吻合器、单向 JJ 吻合和手工缝合共同肠切开术观察到较低的再入院率。金钉的再手术率较低。否则，SSI 无统计学差异。
我们减肥外科组的 RYGB 中的某些手术技术对总不良结果、出血、再入院和再手术的发生率有显著影响。我们的发现需要通过多变量回归模型或前瞻性研究设计进一步研究上述技术。
这项研究受到其回顾性和单变量统计设计的固有性质的限制。我们没有考虑技术之间的相互作用。外科医生的样本量较小，随访时间相对较短为 30 天。我们没有将患者特征纳入模型，也没有控制外科医生的技能。
