Zusammenfassung
GRUNDLAGEN: Strikturraten der Gastrojejunostomie (GJA) bei laparoskopischem Magenbypass (LGBP) werden 1,6%–40% für zirkulären und 3%–14,6% für linearen Stapler angegeben. Diese Studie hat beide Anastomosentechniken in Hinblick auf die Strikturrate verglichen. METHODIK: Prospektive Studie, es wurde Magenbypass mit antekolischer, antegastrischer Y-Roux-Anastomose mit zirkulärem 25 mm Stapler vs. Linearstapler (+2 fortlaufende Nähte) verglichen. Strikturdefinition: symptomatische Wegsamkeitsstörung, die endoskopische Ballondilatation zur Wiederherstellung der Durchgängigkeit für ein 9,8 mm Endoskop benötigte. Werte wurden als Median und Range angegeben. ERGEBNISSE: Keine Mortalität. 39 Patienten in jeder Gruppe, mit vergleichbarem Alter und Geschlechtsverteilung, Anästhesiescore, BMI (46,2 vs. 51) und Begleiterkrankungen. Blutverlust, Spitalsaufenthaltsdauer, Komplikationen und Re-Operationen waren vergleichbar. OP-Zeit war länger und Konversion häufiger bei zirkulärer Staplertechnik (p < 0,001). Strikturraten und endoskopische Ballondilatation waren vergleichbar (p = 0,146 bzw. 0,146). SCHLUSSFOLGERUNGEN: Es fand sich kein signifikanter Unterschied bezüglich Strukturrate nach zirkuläre vs. linear gestapelter Gastrojejunostomie bei laparoskopischem Magenbypass. Größere Studien mit entsprechender Strikturklassifikation sind zu empfehlen.
Summary
BACKGROUND: The literature shows that stricture rates at gastrojejunal anastomosis (GJA) following laparoscopic gastric bypass (LGBP) vary from 1.6% to 40% for circular stapled (CSA) and 3% to 14.6% for linear stapled (LSA) GJA. The aim of this study was to evaluate whether circular stapled versus linear stapled GJA impacts stricture rates. METHODS: This was a prospective, concurrent cohort study. Patients underwent ante-colic, ante-gastric Roux-en-Y LGBP with either circular stapled GJA (25-mm circular stapler) or with linear stapled GJA (2 layers of running sutures). GJA stricture was defined by obstructive symptoms with a GJA requiring endoscopic balloon dilatation to allow passage of a 9.8 mm endoscope. Values were median (range). RESULTS: There were no deaths. There were 39 patients in the CSA and 39 patients in the LSA arms. Patients were well-matched for age 41 (23–55) vs. 44 (29–62) years, gender (35: 4 vs. 31: 8), American Society of Anesthesiology score (14: 20: 5 vs. 0: 38: 1), body mass index 46.2 (35–66.7) vs. 51.0 (37–73) and co-morbidities 4 (2–10) vs. 4 (1–7). There were no significant differences in estimated blood loss 50 (50–3000) vs. 50 (50–75) ml, length of stay 4 (3–48) vs. 4 (3–8) days, complications (7 vs. 3) and re-operations (2 vs. 2). Operating time 196 (140–370) vs. 90 (60–120) (p ≪ 0.001) min, conversions (7 vs. 0 p = 0.002), and differed. Stricture (7 vs. 2 p = 0.146) and endoscopic balloon dilation (12 vs. 4 p = 0.083) rates at a follow-up of 12 (8–18) months did not differ significantly. Time to presentation after surgery for the strictures was 36.5 (33–42) vs. 26.5 (24–29) days in the CSA and in the LSA arms, respectively. The percentage of excess body weight loss at 1 year was similar (80% vs. 78%). CONCLUSIONS: This underpowered study did not detect a significant difference in stricture rates at the GJA after CSA or LSA. Strictures were safely and successfully treated by endoscopic balloon dilation. Larger studies with a widely accepted classification of GJA stricture would be appropriate.
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Haughn, C., Calic, S., Carrodeguas, L. et al. Stricture rates after circular stapled vs. linear stapled gastro-jejunostomy for laparoscopic gastric bypass. Eur Surg 38, 405–410 (2006). https://doi.org/10.1007/s10353-006-0294-0
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DOI: https://doi.org/10.1007/s10353-006-0294-0