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Does experience preclude leaks in laparoscopic gastric bypass?

机译：是否可以排除腹腔镜胃旁路手术中的渗漏？

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BACKGROUND: Improved outcomes of laparoscopic Roux-en-Y gastric bypass (LRYGB) have been demonstrated once pratice has moved beyond the learning curve. However, there is no evidence that experience has a favorable impact on the incidence of leaks. This study evaluated the incidence of staple-line leaks as experience accrued in a university-based bariatric surgery program. METHODS: Prospectively collected data on our first 200 patients undergoing LRYGB since July 1998 were analyzed. Linear staplers were used to divide the stomach and to create a side-to-side jejunojejunostomy. A side-to-side cardiojejunostomy was created using a 21-mm circular stapler. Patient characteristics, operative data, and outcomes were evaluated chronologically with comparison of outcomes between quartiles. RESULTS: Staple-line leaks developed in 9 (4.5%) of the first 200 patients undergoing LRYGB. Among the 200 patients were 190 women (95%). The median age of the patients was 48 years (ranges, 24-62 years), and their body mass index was 43 kg/m(2) (ranges, 32-59 kg/m(2)). As surgeons' experience increased over time, there was a significant increase in the weight of patients and the percentage of patients with previous abdominal operations. There also was a significant decrease in conversion rates and operative times. Leaks occurred in six patients at the cardiojejunostomy (3%), in two patients jejunojejunostomy (1%), and in one patient at the excluded stomach (0.5%). Of the 50 leaks that occurred in each quartile, there were in the 3 in the 1st quartile, 1 in the 2nd quartile, 2 in the 3rd quartile, 3 in the 4th quartile. The differences were not significant. There was no correlation between the number of LRYGBs, and the occurrence of a leak (p = 0.59 confidence interval -0.13-0.22). CONCLUSIONS: The incidence of staple-line leaks appears to be independent of the number of LRYGBs performed. These data suggest that surgeons' experience may not eliminate anastomotic complications experienced by patients undergoing LRYGB.
机译：背景：一旦实践已经超越了学习曲线，腹腔镜Roux-en-Y胃旁路术（LRYGB）的结果就得到了改善。但是，没有证据表明经验对泄漏的发生有有利的影响。这项研究根据大学减肥手术计划中的经验评估了吻合钉钉线漏的发生率。方法：前瞻性收集了自1998年7月以来我们接受LRYGB治疗的200例患者的数据。线性缝合器用于分隔胃并形成空侧空肠吻合术。使用21毫米圆形吻合器进行了一侧到另一侧的空肠吻合术。按时间顺序评估患者特征，手术数据和结果，并比较四分位数之间的结果。结果：在接受LRYGB的前200例患者中，有9例（4.5％）出现了吻合钉线渗漏。在200名患者中，有190名妇女（95％）。患者的中位年龄为48岁（范围为24-62岁），其体重指数为43 kg / m（2）（范围为32-59 kg / m（2））。随着外科医生经验的增加，患者的体重和以前进行过腹部手术的患者的百分比显着增加。转化率和手术时间也明显减少。在空肠造口术中有6例患者发生渗漏（3％），在空肠造口术中有2例患者发生渗漏（1％），在胃排空处有1例患者发生渗漏（0.5％）。在每个四分位数中发生的50个泄漏中，第一四分位数中有3个，第二四分位数中有1个，第三四分位数中有2个，第四四分位数中有3个。差异不显着。 LRYGB的数量与泄漏的发生之间没有关联（p = 0.59置信区间-0.13-0.22）。结论：钉线泄漏的发生似乎与所执行的LRYGB的数量无关。这些数据表明，外科医生的经验可能无法消除LRYGB患者所经历的吻合并发症。

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