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腹腔镜Roux-en-Y胃旁路术中长与短胃囊比较:更多吻合口溃疡、更少倾倒综合征及相同体重减轻情况

More Anastomotic Ulcers, Less Dumping, and Equal Weight Loss in Long vs. Short Gastric Pouch in Laparoscopic Roux-en-Y Gastric Bypass.

作者信息

Bühler Gaby, Schneider Romano, Kraljević Marko, Süsstrunk Julian, Fourie Lana, Woellnerhanssen Bettina, Peterli Ralph

机构信息

Department of Visceral Surgery, Clarunis, University Digestive Health Care Center Basel, St. Clara Hospital and University Hospital Basel, Basel, Switzerland.

Department of Clinical Research, Medical Faculty of the University of Basel, St. Clara Research, St. Clara Hospital, Basel, Switzerland.

出版信息

Obes Surg. 2025 Feb;35(2):450-456. doi: 10.1007/s11695-024-07645-z. Epub 2025 Jan 8.

Abstract

BACKGROUND

Anastomotic ulcers (AU) at the gastroenterostomy are a common postoperative complication after laparoscopic Roux-en-Y gastric bypass (LRYGB). Possible risk factors for ulcer formation include active smoking, the use of non-steroidal anti-inflammatory drugs, increased tension or ischemia at the anastomosis, or factors that increase the acid secretion of the gastric pouch. Therefore, a longer gastric pouch may increase risk of AU formation after LRYGB.

METHODS

This study is a retrospective analysis of prospective collected data from patients undergoing LRYGB between 2009 and 2019 with a minimum follow-up of 2 years. In 2018, we changed the operative technique from short to long gastric pouch LRYGB. We analyzed AU formation, dumping syndrome, age, weight evolution, obesity-associated medical problems, and NSAID in two groups: long (LP-GP) vs. short pouch (SP-GP) LRYGB.

RESULTS

A total of 1058 patients were included in the analysis (178 with LP-GP and 880 with SP-GP). A long gastric pouch significantly increased the rate of AU (LP-GP 12.4% vs. SP-GP 2.6%, p ≤ 0.01, OR 5.3). In contrast, the appearance of dumping syndrome improved in patients undergoing LP-GP (LP-GP 49% vs. SP-GP 60%, P ≤ 0.01, OR 1.5). However, no difference was observed between the groups in terms of weight loss in the first 2 years postoperative.

CONCLUSION

LRYGB with a long compared to a short gastric pouch increases the rate of AU while decreasing the appearance of dumping syndrome. These findings influence the postoperative course of patients undergoing LRYGB, particularly concerning prolonged proton pump inhibitor prophylaxis and a possible tailored surgical approach.

摘要

背景

胃肠吻合口处的吻合口溃疡(AU)是腹腔镜Roux-en-Y胃旁路术(LRYGB)后常见的术后并发症。溃疡形成的可能危险因素包括主动吸烟、使用非甾体类抗炎药、吻合口处张力增加或缺血,或增加胃小囊酸分泌的因素。因此,更长的胃小囊可能会增加LRYGB术后AU形成的风险。

方法

本研究是一项对2009年至2019年间接受LRYGB且至少随访2年的患者前瞻性收集数据的回顾性分析。2018年,我们将手术技术从短胃小囊LRYGB改为长胃小囊LRYGB。我们分析了长胃小囊组(LP-GP)与短胃小囊组(SP-GP)LRYGB患者的AU形成、倾倒综合征、年龄、体重变化、肥胖相关的医学问题和非甾体类抗炎药使用情况。

结果

共有1058例患者纳入分析(178例为LP-GP,880例为SP-GP)。长胃小囊显著增加了AU发生率(LP-GP为12.4%,SP-GP为2.6%,p≤0.01,OR为5.3)。相比之下,接受LP-GP手术的患者倾倒综合征的发生率有所改善(LP-GP为49%,SP-GP为60%,P≤0.01,OR为1.5)。然而,两组术后前两年的体重减轻情况没有差异。

结论

与短胃小囊相比,长胃小囊的LRYGB增加了AU发生率,同时减少了倾倒综合征的发生。这些发现影响了接受LRYGB患者的术后病程,特别是在延长质子泵抑制剂预防时间和可能采用个性化手术方式方面。

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