Department of Surgery, Michigan Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, 2210 Taubman Center, Ann Arbor, MI, 48109, USA.
Department of Surgery, Henry Ford Health, Detroit, MI, USA.
Surg Endosc. 2023 Nov;37(11):8464-8472. doi: 10.1007/s00464-023-10434-x. Epub 2023 Sep 22.
Technical variation exists when performing the gastrojejunostomy during Roux-en-Y gastric bypass (RYGB). However, it is unclear whether changing technique results in improved outcomes or patient harm.
Surgeons participating in a state-wide bariatric surgery quality collaborative who completed a survey on how they perform a typical RYGB in 2011 and again in 2021 were included in the analysis (n = 31). Risk-adjusted 30-day complication rates and case characteristics for cases in 2011 were compared to those in 2021 among surgeons who changed their gastrojejunostomy technique from end-to-end anastomosis (EEA) to either a linear staple or handsewn anastomosis (LSA/HSA). In addition, case characteristics and outcomes among surgeons who maintained an EEA technique throughout the study period were assessed.
A total of 15 surgeons (48.3%) changed their technique from EEA to LSA/HSA while 7 surgeons (22.3%) did not. Nine surgeons did LSA or HSA the entire period and therefore were not included. Surgeons who changed their technique had significantly lower rates of surgical complications in 2021 when compared to 2011 (1.9% vs 5.1%, p = 0.0015), including lower rates of wound complications (0.5% vs 2.1%, p = 0.0030) and stricture (0.1% vs 0.5%, p = 0.0533). Likewise, surgeons who did not change their EEA technique, also experienced a decrease in surgical complications (1.8% vs 5.8%, p < 0.0001), wound complications (0.7% vs 2.1%, p < 0.0001) and strictures (0.2% vs 1.2%, p = 0.0006). Surgeons who changed their technique had a significantly higher mean annual robotic bariatric volume in 2021 (30.0 cases vs 4.9 cases, p < 0.0001) when compared to those who did not.
Surgeons who changed their gastrojejunostomy technique from circular stapled to handsewn demonstrated greater utilization of the robotic platform than those who did not and experienced a similar decrease in adverse events during the study period, despite altering their technique. Surgeons who chose to modify their operative technique may be more likely to adopt newer technologies.
在 Roux-en-Y 胃旁路术（RYGB）中进行胃空肠吻合术时存在技术差异。然而，目前尚不清楚改变技术是否会带来更好的结果或患者伤害。
参与全州减重手术质量合作的外科医生在 2011 年和 2021 年完成了一项关于他们如何进行典型 RYGB 的调查，分析中包括了这些外科医生（n=31）。比较了 2011 年和 2021 年接受过技术改变（端端吻合术[EEA]改为线性吻合或手工吻合术[LSA/HSA]）的外科医生的 30 天风险调整并发症发生率和病例特征。此外，还评估了在整个研究期间保持 EEA 技术的外科医生的病例特征和结局。
共有 15 名外科医生（48.3%）将技术从 EEA 改为 LSA/HSA，而 7 名外科医生（22.3%）没有。9 名外科医生在整个研究期间都进行了 LSA 或 HSA，因此未被包括在内。与 2011 年相比，2021 年改变技术的外科医生的手术并发症发生率显著降低（1.9%比 5.1%，p=0.0015），包括伤口并发症（0.5%比 2.1%，p=0.0030）和狭窄（0.1%比 0.5%，p=0.0533）。同样，未改变 EEA 技术的外科医生的手术并发症（1.8%比 5.8%，p<0.0001）、伤口并发症（0.7%比 2.1%，p<0.0001）和狭窄（0.2%比 1.2%，p=0.0006）也有所下降。与未改变技术的外科医生相比，改变技术的外科医生在 2021 年的平均年度机器人减重手术量明显更高（30.0 例比 4.9 例，p<0.0001）。
与未改变技术的外科医生相比，将胃空肠吻合术从圆形吻合改为手工吻合的外科医生使用机器人平台的比例更高，并且在研究期间经历了类似的不良事件减少，尽管改变了技术。选择修改手术技术的外科医生可能更愿意采用新技术。
