Standardization of the Fully Stapled Laparoscopic Roux-en-Y Gastric Bypass for Obesity Reduces Early Immediate Postoperative Morbidity and Mortality: A Single Center Study on 2606 Patients
Standardization of the Fully Stapled Laparoscopic Roux-en-Y Gastric Bypass for Obesity Reduces Early Immediate Postoperative Morbidity and Mortality: A Single Center Study on 2606 Patients
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DOI：
10.1007/s11695-009-9933-4
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发表时间：
2009-10-01
期刊：
影响因子：
2.9
通讯作者：
Proot, Luc
中科院分区：
文献类型：
--
作者：
Dillemans, Bruno;Sakran, Nasser;Proot, Luc
腹腔镜Roux-en-Y胃旁路术的各种技术已被描述。我们完全标准化这一程序，以尽量减少其有时大量的发病率和死亡率。本研究描述了我们使用标准化完全吻合器腹腔镜Roux-en-Y胃旁路术（FS-LRYGB）的经验及其对30天发病率和死亡率的影响，我们回顾性分析了2004年5月至2008年8月期间接受FS-LRYGB的2，645例患者。然后计算手术时间、住院时间和再入院率、再手术率和30天发病率/死亡率。2，606例患者（98.5%）的30天随访数据完整，其中男性539例，女性2，067例。平均年龄为39.2岁（范围14-73），平均BMI为41.44 kg/m2（范围23-75.5）。平均住院时间为3.35天（范围2-71天）。平均总手术时间为63分钟（范围35-150分钟）。1例患者在手术后30天内死于肺炎（0.04%）。术后并发症151例（5.8%），消化道出血89例（3.42%），肠梗阻9例（0.35%），吻合口瘘5例（0.19%），其他47例（1.80%）。在66例患者中，出血在没有任何手术再次干预的情况下消退。一例出血导致低血容量性休克，随后出现肾和肝功能衰竭。系统的方法和完全标准化的FS-LRYGB程序有助于我们机构非常低的死亡率和低发病率。胃肠道出血似乎是最常见的并发症，但在大多数情况下是自限性的。我们的方法还显著缩短了手术时间，并将技术要求苛刻的腹腔镜Roux-en-Y胃旁路手术变成了一种易于重复的手术，对培训有效。
Various techniques of laparoscopic Roux-en-Y gastric bypass have been described. We completely standardized this procedure to minimize its sometimes substantial morbidity and mortality. This study describes our experience with the standardized fully stapled laparoscopic Roux-en-Y gastric bypass (FS-LRYGB) and its influence on the 30-day morbidity and mortality.We retrospectively analyzed 2,645 patients who underwent FS-LRYGB from May 2004 to August 2008. Operative time, hospital stay and readmission, re-operation, and 30-day morbidity/mortality rates were then calculated. The 30-day follow-up data were complete for 2,606 patients (98.5%).There were 539 male and 2,067 female patients. Mean age was 39.2 years (range 14-73), mean BMI 41.44 kg/m(2) (range, 23-75.5). The mean hospital stay was 3.35 days (range 2-71). Mean total operative time was 63 min (range 35-150).One patient died of pneumonia within 30 days of surgery (0.04%). One hundred and fifty one (5.8%) patients had postoperative complications as follows: gastrointestinal hemorrhage (n = 89, 3.42%), intestinal obstruction (n = 9, 0.35%), anastomotic leak (n = 5, 0.19%) and others (n = 47, 1.80%). In 66 patients, the bleeding resolved without any surgical re-intervention. One hemorrhage resulted in hypovolemic shock with subsequent renal and hepatic failure.The systematic approach and the full standardization of the FS-LRYGB procedure contribute highly to the very low mortality and the low morbidity rates in our institution. Gastrointestinal bleeding appears to be the commonest complication, but is self-limiting in the majority of cases. Our approach also significantly reduces operative time and turns the technically demanding laparoscopic Roux-en-Y gastric bypass procedure into an easy reproducible operation, effective for training.