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胃外科中手动吻合器与电动吻合器使用效果的前瞻性研究。

RESULTS OF MECHANIC VERSUS MOTORIZED STAPLER USED IN GASTRIC SURGERY: PROSPECTIVE STUDY.

机构信息

Digestive and Bariatric Surgical Unit, Redsalud Providencia, Santiago, Chile.

出版信息

Arq Bras Cir Dig. 2024 Aug 30;37:e1818. doi: 10.1590/0102-6720202400025e1818. eCollection 2024.

DOI:10.1590/0102-6720202400025e1818
PMID:39230118
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11363907/
Abstract

BACKGROUND

Mechanic sutures represent an enormous benefit for digestive surgery in decreasing postoperative complications. Currently, the advantages of motorized stapler are under evaluation.

AIMS

To compare the efficacy of mechanic versus motorized stapler in gastric surgery, analyzing rate of leaks, bleeding, time of stapling, and postoperative complications.

METHODS

Ninety-eight patients were submitted to gastric surgery, divided into three groups: laparoscopic sleeve gastrectomy (LSG) (n=47), Roux-en-Y gastric bypass (LRYGB) (n=30), and laparoscopic distal gastrectomy (LDG) (n=21). Motorized staplers were employed in 61 patients. The number of firings, number of clips, time of total firings, total time to complete the surgery, and postoperative outcome were recorded in a specific protocol.

RESULTS

Patients submitted to LSG, LRYGB, and LDG recorded a shorter time to complete the procedure and a smaller number of firings were observed using motorized stapler (p<0.0001). No differences were identified regarding the number of clips used in patients submitted to LSG. In the group that used mechanic stapler to complete gastrojejunostomy, jejuno-jejuno-anastomosis, and jejunal transection, it was observed more prolonged time of firing and total time for finishing the procedure (p=0.0001). No intraoperative complications were found comparing the two devices used. Very similar findings were noted in the group of patients undergoing LDG.

CONCLUSIONS

The motorized stapler offers safety and efficacy as demonstrated in prior reports and is relevant since less total time of surgical procedure without intraoperative or postoperative complications were confirmed.

摘要

背景

机械缝合在减少术后并发症方面对消化外科有巨大的益处。目前,电动吻合器的优势正在评估中。

目的

比较机械吻合与电动吻合在胃外科中的疗效,分析吻合口漏、出血、吻合时间和术后并发症的发生率。

方法

98 例患者接受胃外科手术,分为三组:腹腔镜袖状胃切除术(LSG)(n=47)、Roux-en-Y 胃旁路术(LRYGB)(n=30)和腹腔镜远端胃切除术(LDG)(n=21)。61 例患者使用电动吻合器。在特定方案中记录吻合器的击发次数、夹的数量、总击发时间、完成手术的总时间和术后结果。

结果

接受 LSG、LRYGB 和 LDG 的患者完成手术的时间更短,使用电动吻合器的击发次数更少(p<0.0001)。接受 LSG 的患者使用的夹的数量没有差异。在使用机械吻合器完成胃空肠吻合、空肠空肠吻合和空肠切断的患者中,观察到的击发时间和完成手术的总时间更长(p=0.0001)。比较两种器械,未发现术中并发症。在接受 LDG 的患者中也观察到了非常相似的结果。

结论

电动吻合器具有安全性和有效性,与既往报道一致,且证实了总手术时间更短,无术中或术后并发症。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0ce/11363907/6d3abd151050/0102-6720-abcd-37-e1818-gf01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0ce/11363907/6d3abd151050/0102-6720-abcd-37-e1818-gf01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c0ce/11363907/6d3abd151050/0102-6720-abcd-37-e1818-gf01.jpg

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Timing and management of bleeding after bariatric surgery.肥胖症手术后出血的时机和处理。
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