Villagrán Rodrigo, Mercandino Antonio, Aros Nelson, Eluzen Nasser, Carreño Bárbara, Cariaga Mario, Sanhueza-Olivares Fernanda
Clínyco Medical Center, Antofagasta, Chile.
Clínica Bupa Antofagasta, Antofagasta, Chile.
Obes Surg. 2025 Aug 6. doi: 10.1007/s11695-025-08117-8.
Laparoscopic Roux-en-Y gastric bypass (L-RYGB), a common procedure for treating obesity, requires a gastrojejunostomy (GJA). The most used techniques for GJA, namely, linear stapling and hand-sewing, have similar outcomes. Since GJA is time-consuming, optimizing GJA would provide a strategic opportunity to reduce surgical times. We describe a completely mechanical GJA (CM-GJA) to standardize its configuration and reduce the creation time of CJA. Additionally, we present our initial experience and learning curve with this technique.
Retrospective analysis with prospective follow-up of a cohort of 166 patients who underwent L-RYGB or conversion to L-RYGB in Antofagasta, Chile, from January 2020 to January 2023. Patients were divided into four chronological groups based on the date of surgery to evaluate the CM-GJA creation times, and the demographics, surgical aspects, complications, and percentage of excess BMI loss (%EBMIL) at 6 months were analyzed.
Average time for CM-GJA creation was 4 min 34 s. There was a significant reduction in CM-GJA creation time, from 4 min 43 s to 4 min 24 s (p < 0.001). Mean BMI decreased from 41.30 to 30.71 after 6 months; moreover, 82.5% of patients had a %EBMIL ≥ 50%, and 51.8% had a %EBMIL > 65%. Strictures occurred in 1.8% of patients.
CM-GJA implementation in L-RYGB yielded an optimal clinical response, as shown by the procedural learning curve and patient outcomes. These findings suggest that CM-GJA not only reduces GJA creation times but may also enhance safety, supporting its broader adoption in clinical practice.
腹腔镜Roux-en-Y胃旁路术（L-RYGB）是治疗肥胖症的常见手术，需要进行胃空肠吻合术（GJA）。GJA最常用的技术，即线性吻合器缝合和手工缝合，效果相似。由于GJA耗时较长，优化GJA将为缩短手术时间提供战略契机。我们描述了一种完全机械的GJA（CM-GJA），以规范其配置并减少CJA的创建时间。此外，我们介绍了我们使用该技术的初步经验和学习曲线。
对2020年1月至2023年1月在智利安托法加斯塔接受L-RYGB或转为L-RYGB的166例患者进行回顾性分析，并进行前瞻性随访。根据手术日期将患者分为四个时间组，以评估CM-GJA的创建时间，并分析6个月时的人口统计学、手术情况、并发症以及超重BMI损失百分比（%EBMIL）。
CM-GJA创建的平均时间为4分34秒。CM-GJA的创建时间显著缩短，从4分43秒降至4分24秒（p < 0.001）。6个月后平均BMI从41.30降至30.71；此外，82.5%的患者%EBMIL≥50%，51.8%的患者%EBMIL>65%。1.8%的患者出现狭窄。
如手术学习曲线和患者结果所示，在L-RYGB中实施CM-GJA产生了最佳的临床反应。这些发现表明，CM-GJA不仅减少了GJA的创建时间，还可能提高安全性，支持其在临床实践中更广泛地应用。
