Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients - What have we learned?
Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients - What have we learned?
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DOI：
10.1381/096089200321593706
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发表时间：
2000-12-01
期刊：
影响因子：
2.9
通讯作者：
Ho, TC
中科院分区：
文献类型：
--
作者：
Higa, KD;Boone, KB;Ho, TC
背景：Roux-en-Y胃旁路术（RYGBP）是治疗病态肥胖最常见的手术之一。已经报道了腹腔镜技术，但与传统的"开放"手术相比，其患者数量少，手术时间长，初始并发症发生率似乎更高。微创方法仍然是一个挑战，即使是最有经验的腹腔镜外科医生。本研究的目的是描述我们的经验和并发症的腹腔镜Roux-en-Y胃旁路术与完全手工缝合胃空肠吻合术，方法：前瞻性评价了1,040例连续腹腔镜手术。最初仅排除了既往接受过开放式胃手术的患者，最终，即使是"开放式"减肥手术和其他胃手术失败的患者也通过腹腔镜进行RYGBP翻修。所有患者符合NIH标准考虑减重surgery. Results：有没有吻合口瘘的手缝胃空肠吻合。早期并发症和开放转换与次优暴露和肠固定技术有关。几次吻合钉失效归因于制造商对手术工具的重新设计，所有患者的平均住院时间为1.9天，无并发症患者的平均住院时间为1.5天，手术时间始终接近60分钟。在12个月时，平均过量体重减轻70%。有5例死亡：围手术期肺栓塞（1例）、晚期肺栓塞（2例）、哮喘（1例）和自杀（1例）。结论：在社区环境中，具有先进腹腔镜技术的肥胖外科医生可以安全地进行腹腔镜Roux-en-Y胃旁路术，并进行完全手工缝合的胃空肠吻合术。必须使用不可吸收缝线固定和闭合所有潜在疝部位。手缝胃空肠吻合口狭窄可采用内镜球囊扩张术。必须高度重视患者的手术和围手术期护理。
Background: The Roux-en-Y gastric bypass (RYGBP) is one of the most common operations for morbid obesity. Laparoscopic techniques have been reported, but suffer from small numbers of patients, longer operative times and seemingly higher initial complication rates as compared to the traditional "open" procedure. The minimally invasive approach continues to be a challenge even to the most experienced laparoscopic surgeons. The purpose of this study is to describe our experience and complications of the laparoscopic Roux-en-Y gastric bypass with a totally hand-sewn gastrojejunostomy,Methods: 1,040 consecutive laparoscopic procedures were evaluated prospectively. Only patients who had a previous open gastric procedure were excluded initially, Eventually, even patients with failed "open" bariatric procedures and other gastric procedures were revised laparoscopically to the RYGBP. All patients met NIH criteria for consideration for weight reductive surgery.Results: There were no anastomotic leaks from the hand-sewn gastrojejunostomy. Early complications and open conversions were related to sub-optimal exposure and bowel fixation techniques. Several staple failures were attributed to a manufacturer redesign of an instrument, Average hospital stay was 1.9 days for all patients and 1.5 days for patients without complications, Operative times consistently approach 60 minutes. Average excess weight loss was 70% at 12 months. There were 5 deaths: perioperative pulmonary embolism (1), late pulmonary embolism (2), asthma (1), and suicide (1),Conclusions: The laparoscopic Roux-en-Y gastric bypass for morbid obesity with a totally hand-sewn gastrojejunostomy can be safely performed by the bariatric surgeon with advanced laparoscopic skills in the community setting, Fixation and closure of all potential hernia sites with non-absorbable sutures is essential. Stenosis of the hand-sewn gastrojejunal anastomosis is amenable to endoscopic balloon dilation. Meticulous attention must be paid to the operative and perioperative care of the patient.