Functional Roux-en-Y Gastric Bypass (F-RYGB), with Preservation of Duodenal Access: Report of Two Revisional Cases of Sleeve Gastrectomy

Objective: This case report aimed to demonstrate a possible neuromuscular effect of Latarjet nerves transection or truncal vagotomy, in association with sleeve gastrectomy plus antrojejunostomy, in order to reproduce a Roux-en-Y gastric bypass (RYGB) mechanistic principles, in patients with previous Sleeve Gastrectomy (SG) who had had weight regain, with or without concomitant gastroesophageal reflux disease (GERD). Background: Sleeve gastrectomy (SG) is one of the most frequently performed bariatric operations worldwide. Nevertheless, weight regain and gastroesophageal reflux disease (GERD) have been consistently demonstrated, in association with this technique, which may require a revisional procedure. RYGB is an option in such a situation but, implies in gastrointestinal exclusions, which represents a shortcoming of this revision. Surpassing this inconvenient would be of great value for the patients. Methods: We describe herein two cases of SG revision for weight regain and GERD, with a follow-up of one year. Gastroesophageal reflux disease was evaluated by validated questionnaire, upper endoscopy, seriography, high resolution manometry (HRM) and impedance pHmetry (I-pHmetry), in the pre and postoperative periods. A re-Sleeve Gastrectomy with antrojejunal anastomosis was done in both cases, after informed consents. The Latarjet nerves were transected in one case, due to a bleeding in the left gastric vessels and a truncal vagotomy was required in the other, to appropriately treat an associated hiatal hernia. Results: In the postoperative evaluation it was observed a pyloric spasm in both cases, during seriography and endoscopy, kept until the one-year follow-up. There was unidirectional contrast flow to the gastrointestinal anastomosis, filling the jejunal limb, in radiologic contrast study. No contrast passed through the pylorus. Nonetheless, the duodenum was kept endoscopically accessible. In the one-year evaluation, weight loss was adequate and GERD resolution was obtained in both cases, confirmed by endoscopic and functional esophageal assessment, together with symptoms questionnaire. Conclusion: The association of Latarjet nerves sectioning or truncal vagotomy with re-sleeve gastrectomy plus gastrointestinal anastomosis (antrojejunal), in a revision for a failed sleeve, can represent a technical approach, to reproduce RYGB results, without exclusions and with duodenum endoscopic accessibility maintenance. It maybe could be applied for primary surgeries. Additional studies are necessary to confirm this hypothesis.

Gastroenteroanastomosis Techniques for Laparoscopic Gastric Bypass: Linear vs Circular Stapler

Background: Laparoscopic Roux-en-Y gastric bypass (LRYGB) is an effective and well-accepted procedure for the treatment of morbid obesity but has complications such as stenosis of the gastroenteroanastomosis (GE), GE leak, surgical site infection, and stapling malfunction. This study evaluated the efficiency of weight loss and the incidence of short- and mid-term postoperative complications in patients undergoing LRYGB in which anastomosis was performed using a linear stapler (LSA) or a circular stapler (CSA). Methods: Prospective observational study conducted between April 2016 and March 2019. The data were extracted from a hospital database that includes patients undergoing LRYGB in two different GE techniques, assessing postoperative complications and excess body weight loss. Results: Data from 457 patients were analyzed, of which 216 were in the LSA group and 241 were in the CSA group. There were four cases (1.7%) of GE stenosis in the CSA group and only one (0.5%) in the LSA group. Stapler malfunction occurred in both groups: CSA (0.4%) and LSA (0.5%), and a GE leak developed only in the CSA group (0.4%). Surgical site infection was found in five patients in the CSA group (2.1%) and two in the LSA group (0.9%). No statistical difference was found between the two groups in any of the variables analyzed (p > 0.05). Conclusions: Both stapling techniques resulted in a similar loss of excess body weight during the follow-up period. Although the LSA group had fewer total complications, these were not statistically significant, which substantiates the fact that both techniques are safe and feasible, provided they are performed by a surgeon with a long learning curve in laparoscopic bariatric surgery.

直线切割吻合器在儿童腹腔镜胆总管囊肿根治术Roux-en-Y吻合中的应用

目的探讨直线切割吻合器应用于儿童腹腔镜胆总管囊肿根治术Roux-en-Y吻合中的有效性、安全性及可行性。方法本研究为前瞻性研究,选取2020年1月至2023年1月湖南省儿童医院接受腹腔镜胆总管囊肿根治术Roux-en-Y吻合的34例患儿作为研究对象,按照随机数字表法进行分组,采用直线切割吻合器实施Roux-en-Y吻合术的患儿纳入观察组(n=17),采用传统缝合法实施Roux-en-Y吻合术的患儿纳入对照组(n=17)。记录两组患儿手术时长、术中出血量、术后肠道功能恢复时间、首次进食流质时间、拔除引流管时间、术后住院时间、总住院费用和术后并发症发生率。结果34例均顺利完成手术,无一例中转开放手术。观察组与对照组手术时长[(130.43±31.32)min比(141.51±30.39)min]、术中出血量[(55.45±20.73)mL比(58.62±22.13)mL]差异均无统计学意义(P>0.05);观察组与对照组患儿术后肠道功能恢复时间[(4.03±0.42)min比(4.91±1.13)min]、首次进食流质时间[(3.95±0.61)d比(4.88±1.09)d]、拔除引流管时间[(5.95±0.68)d比(6.65±1.28)d]、术后住院时间[(8.29±2.17)d比(10.33±2.18)d]均短于对照组,差异均有统计学意义(P<0.05);观察组与对照组患儿总住院费用[(34948.17±1019.57)元比(35151.91±1151.15)元]、并发症发生率(1/17比2/17)差异无统计学意义(P>0.05)。结论直线切割吻合器在儿童腹腔镜胆总管囊肿根治术Roux-en-Y吻合中与传统缝合吻合技术的有效性和安全性无明显差异,可促进患儿术后恢复,值得临床推广应用。

腹腔镜Roux-en-Y胃旁路术治疗肥胖糖尿病20例疗效分析

目的探讨腹腔镜Roux-en-Y胃旁路手术(LRYGB)治疗肥胖糖尿病的临床疗效。方法回顾性分析2012年~2018年新疆维吾尔自治区人民医院微创、疝腹壁外科中心实施LRYGB的20例肥胖糖尿病人的临床资料。结果20例手术均顺利完成,中转开腹病例1例。手术时间60~420分钟,平均(150±105.64)分钟,术中失血量20~100ml,平均(37.5±20.99)ml,术后住院时间5~15天,平均(8.25±2.51)天。术后5年内7例(35.00%)发生并发症,均为Clavien-Dindo分级Ⅱ级。术后1、3、5年的体重、体质指数(BMI)、糖化血红蛋白、空腹血糖、总体重减少百分比(TWL%)与术前比较均有改善,差异有统计学意义(P<0.05)。术后5年LRYGB治疗2型糖尿病完全缓解15例(75.00%)。结论LRYGB对肥胖2型糖尿病病人是一种有效的减重及降糖的术式。

Comparative study of outcomes following laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in morbidly obese patients: A case control study

AIM To compare the impact of laparoscopic Roux-en-Y gastric bypass(LRYGB) and laparoscopic sleeve gastrectomy(LSG) on weight loss and obesity related comorbidities over two year follow-up via case control study design.METHODS Forty patients undergoing LRYGB, who completed their two year follow-up were matched with 40 patients undergoing LSG for age, gender, body mass index and presence of type 2 diabetes mellitus(T2DM). Data of these patients was retrospectively reviewed to compare the outcome in terms of weight loss and improvement in comorbidities, i.e., T2 DM, hypertension(HTN), obstructive sleep apnea syndrome(OSAS), hypothyroidism and gastroesophageal reflux disease(GERD).RESULTS Percentage excess weight loss(EWL%) was similar in LRYGB and LSG groups at one year follow-up(70.5% vs 66.5%, P = 0.36) while it was significantly greater for LRYGB group after two years as compared to LSG group(76.5% vs 67.9%, P = 0.04). The complication rate after LRYGB and LSG was similar(10% vs 7.5%,P = 0.99). The median duration of T2 DM and mean number of oral hypoglycemic agents were higher in LRYGB group than LSG group(7 years vs 5 years and 2.2 vs 1.8 respectively, P < 0.05). Both LRYGB and LSG had significant but similar improvement in T2 DM, HTN, OSAS and hypothyroidism. However, GERD resolved in all patients undergoing LRYGB while it resolved in only 50% cases with LSG. Eight point three percent patients developed new-onset GERD after LSG.CONCLUSION LRYGB has better outcomes in terms of weight loss two years after surgery as compared to LSG. The impact of LRYGB and LSG on T2 DM, HTN, OSAS and hypothyroidism is similar. However, LRYGB has significant resolution of GERD as compared to LSG.

Bariatric surgery in old age:a comparative study of laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy in an Asia centre of excellence

Bariatric surgery has been proved to be the safest and efficient procedure in treating morbid obese patients,but data is still lacking in the elderly population.The aim of our study was to compare the safety and efficacy of laparoscopic Roux-en-Y gastric bypass（LRYGB） and sleeve gastrectomy（LSG） in patients aged more than 55 years.We performed2 a retrospective review of a prospectively collected database.All patients with body mass index（BMI） §32 kg/mand aged more than 55 years undergoing LRYGB or LSG in BMI Surgery Centre,E-Da Hospital between January 2008 and December 2011 with at least one year of follow up were included for the analysis.Demography,peri-operative data,weight loss and surgical complications were all recorded and analyzed.Mean age and BMI of these 68 patients22（22 males and 46 female） were 58.8 years（55-79 years） and 39.5 kg/m（32.00-60.40 kg/m）.LRYGB was performed in 44 patients and LSG in 24 patients.The two groups were comparable in their preoperative BMI,American Society of Anaesthesia（ASA） score and gender distribution.LSG patients were significantly older than patients receiving LRYGB.The proportion of type 2 diabetes preoperatively was significantly higher in LRYGB patients as compared to LSG patients（88.63% vs.50%; P,0.01）.The prevalence of other co-morbidities was similar and comparable2 between the groups.Mean BMI in the LRYGB and LSG groups at the end of 1 year were 28.8 kg/mand228.2 kg/m,respectively,and there was no statistically significant difference in mean percentage of excess weight loss（%EWL） at 1 year.The percentage of resolution of diabetes was significantly higher in LRYGB（69.2%） as compared to LSG（33.3%）.On the other hand,there was no statistical difference in the percentage of resolution of hypertension,hyperlipidemia and fatty liver hepatitis.The overall morbidity and re-operation rate was higher in LRYGB patients.In morbidly elderly patients,both surgeries achieved good weight loss and resolution of comorbidities.LRYGB is superior to LSG in terms of diabetes remission but carries higher complication rates even at high volume centres.

Surgical outcome of laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass for resolution of type 2 diabetes mellitus:A systematic review and meta-analysis

BACKGROUND Bariatric procedures are considered superior to medical therapies in managing type 2 diabetes mellitus(T2DM).Laparoscopic Roux-en-Y gastric bypass(LRYGB)and laparoscopic sleeve gastrectomy(LSG)are the most commonly used procedures for weight loss and comorbidity resolution worldwide.However,it is not yet known whether the degree of T2DM is influenced by the choice of bariatric procedure.AIM To quantitatively compare T2DM resolution over 1-5 years follow-up by LRYGB and LSG in morbidly obese patients.METHODS We searched the selected databases for full-text English language clinical studies that compared the effectiveness of LRYGB and LSG for T2DM resolution.Review manager 5.3 was used for data analysis,and the overall effect summary was represented in a forest plot.RESULTS From 1,650 titles retrieved by an initial search,we selected nine studies for this research.We found insignificant differences for T2DM resolution by LRYGB and LSG,with an odds ratio of 0.93(95%CI:0.64-1.35,Z statistics=0.38,P=0.71).Additionally,subset analyses for T2DM resolution showed insignificant differences after 24 mo(χ^2=1.24,df=4,P=0.87,overall Z effect=0.23),36 mo(χ^2=0.41,df=2,P=0.81,overall Z effect=0.51),and 60 mo(χ^2=4.75,df=3,P=0.19,overall Z effect=1.20)by LRYGB and LSG.This study reports a T2DM remission rate of 82.3%by LRYGB and 80.7%by LSG.CONCLUSION This study reports similar T2DM resolution rates by both LRYGB and LSG during 1-5 years of follow-up.However,long-term follow-up of 10 years is needed to further substantiate these findings.

Computed tomography as primary postoperative follow-up after laparoscopic Roux-en-Y gastric bypass

AIM To evaluate upper abdominal computed tomography(CT) scan as primary follow-up after laparoscopic Rouxen-Y gastric bypass(LRYGB). METHODS This prospective study was approved by the Ethical Committee of the State of Zurich, and informed consent was obtained from all patients. Sixty-one patients who underwent LRYGB received upper abdominal CT on postoperative day 1, with the following scan parameters: 0.6 mm collimation, 1.2 mm pitch, Care KV with reference 120 m As and 120 kV, and 0.5 s rotation time. Diluted water-soluble radiographic contrastmedium(50 mL) was administered to achieve gastric pouch distension without movement of the patient. 3 D images were evaluated to assess postoperative complications and the radiation dose received was analysed. RESULTS From the 70 patients initially enrolled in the study, 9 were excluded from analysis upon the intraoperative decision to perform a sleeve gastrectomy and not a LRYGB. In all of the 61 patients who were included in the analysis, CT was feasible and there were no instances of aspiration or vomiting. In 7 patients, two upper abdominal scans were necessary as the pouch was not distended by contrast medium in the first acquisition. Radiologically, no leak and no relevant stenosis were found on the first postoperative day. These early postoperative CT findings were consistent with the findings at clinical follow-up 6 wk postoperatively, with no leaks, stenosis or obstructions being diagnosed. The average total dose length product in CT was 536.6 m Gycm resulting in an average effective dose of 7.8 m Sv. The most common surgical complication, superficial surgical site infections(n = 4), always occurred at the upper left trocar site, where the circular stapler had been introduced. CONCLUSION Early LRYGB postoperative multislice spiral CT scan is feasible, with low morbidity, and provides more accurate anatomical information than standard upper gastrointestinal contrast study.

Excessive Weight Loss Following Laparoscopic Gastric Mini Bypass or Roux-En-Y Gastric Bypass Surgery

Background: More than 90 percent of obesity surgery is done using a laparoscope. This method is superior to open surgery and lead to fewer complications, shorter hospital stay and faster recovery. This study compared course of weight loss following laparoscopic Gastric Mini Bypass or Roux-En-Y Gastric Bypass surgery, after one year of follow up. Materials and Methods: This randomized clinical trial was conducted among obese patients admitted to Rasoul Akram Hospital Obesity Clinic, Half underwent laparoscopic Roux-En-Y Gastric Bypass and the rest were undergoing laparoscopic Mini Gastric Bypass. The amount of weight loss during the first year after surgery will be discussed. Results: In this study, 75 obese patients were studied. Most of the participants were female (82.7%). Participants aged between 18 and 59 years old (average = 36.8 ± 9.8 y/o). Before the surgery, there was no significant difference in weight between the two groups. Excessive weight loss after one month, six months nine months and one year between the two groups was significant and was more in Mini Gastric Bypass (p < 0.05). Conclusion: Respecting the benefits of Mini Gastric Bypass compared to the Roux-En-Y Gastric Bypass technique, it is suggested for patients with morbid obesity.

毕Ⅰ式吻合术与ROUX-en-Y吻合术在全腹腔镜远端胃癌根治术消化道重建中的效果

目的:比较毕Ⅰ式吻合术与ROUX-en-Y吻合术在全腹腔镜远端胃癌根治术消化道重建中的应用效果。方法:选取2022年1月—2023年12月于甘肃省武威肿瘤医院行全腹腔镜远端胃癌根治术的胃癌患者120例作为研究对象,随机分为对照组和研究组,各60例。对照组采用毕Ⅰ式吻合术进行消化道重建,研究组采用ROUX-en-Y吻合术进行消化道重建。比较两组围术期指标、并发症发生情况、术后疼痛情况及炎性因子水平。结果:研究组术中出血量少于对照组,首次排气时间早于对照组,住院时间短于对照组,差异有统计学意义(P<0.05);两组手术时间比较,差异无统计学意义(P>0.05);研究组并发症总发生率低于对照组,差异有统计学意义(P=0.030);术后12h、24h、48h,研究组视觉模拟评分法评分低于对照组,差异有统计学意义(P<0.001);术后,两组白细胞介素-6、C反应蛋白水平升高,研究组低于对照组,差异有统计学意义(P<0.05)。结论:全腹腔镜远端胃癌根治术消化道重建中采用ROUX-en-Y吻合术较毕Ⅰ式吻合术效果更佳,能降低术中出血量,缩短术后恢复时间,降低并发症发生率,减轻疼痛,缓解炎性反应。

腹腔镜辅助远端胃癌根治术不同Uncut Roux-en-y吻合方式对病人的疗效及对肿瘤标志物和预后的影响

目的探讨不同Uncut Roux-en-y吻合方式对胃癌病人的疗效及对其检验指标和预后的影响。方法我院2018年3月~2021年2月收治的远端胃癌病人96例,均行腹腔镜辅助远端胃癌根治术,根据吻合方式分为两组,其中研究组46例,采用改良U-RY吻合术治疗,对照组病人50例,采用U-RY吻合术治疗,比较两组病人的围术期指标(手术时间、术中出血量、首次通气时间、住院时间及术后第1天引流量)、手术前后肿瘤相关指标(CEA、CA19-9)、术后并发症及术后1年的预后情况。结果除术后第1天引流量外,研究组的其余指标(手术时间、术中出血量、首次通气时间和住院时间)优于对照组(P<0.05);术前两组的肿瘤相关指标(CA19-9、CEA)比较无明显差异(P>0.05),术后两组病人的肿瘤相关指标(CA19-9、CEA)均较术前降低,差异有统计学意义(P<0.05);研究组总并发症发生率比对照组低(8.7%vs 30.0%,P<0.05);术后1年,两组病人的生存率和复发率比较无明显差异(97.8%vs 96.0%,4.3%vs 6.0%,P>0.05)。结论腹腔镜辅助远端胃癌根治术中应用改良U-RY吻合术可显著缩短病人的手术时间,加快病人的康复速度,且可降低其术后并发症发生率,最终不影响病人的预后。

Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI,28kg/m^2:a multi-institutional study

Roux-en-Y gastric bypass surgery（RYGB） has been demonstrated to be successful for treating type-II diabetes2mellitus（T2DM） patients with a body mass index（BMI）,30 kg/m,but reports of RYGB for T2 DM patients with22 a BMI,28 kg/mare lacking.T2 DM patients with a BMI,28 kg/mwere prospectively recruited to participate in this study in four hospitals.The endpoint was T2 DM remission（defined by fasting blood glucose（FBG） level,110 mg/d L and hemoglobin（Hb）A1c level,6.0% at 12 months postoperatively）.Predictors of remission were investigated by univariate and multivariate analyses.Eighty-six patients were assessed.Eighty-five patients underwent RYGB,with one conversion to open surgery.We compared the values of various variables before and after2 surgery.The mean BMI decreased from 24.68±2.12 to 21.72±2.43 kg/m（P,0.001）.Fifty-eight（67.4%） patients were not treated by drugs or insulin after surgery,and 20 patients（23.3%） had complete remission of T2 DM at12 months after surgery with an acceptable number of complications.The mean Hb A1 c level in the remission group was significantly lower than that in the non-remission group.Patients with a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level were more likely to have T2 DM remission in multivariate2 analyses.In conclusion,RYGB was effective and safe for treating T2 DM patients with a BMI,28 kg/m.Complete remission can be predicted by cases having a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level.

Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature

Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidenceof bariatric operations and coherently possible complications after such procedures, which modify patient's anatomy and physiology.

Two case reports of acute upper gastrointestinal bleeding from duodenal ulcers after Roux-en-Y gastric bypass surgery: Endoscopic diagnosis and therapy by single balloon or push enteroscopy after missed diagnosis by standard esophagogastroduodenoscopy

The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass(RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status postRYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.

Effect of Roux-en-Y gastric bypass surgery on intestinal Akkermansia muciniphila

AIM: To investigated changes in intestinal Akkermansia muciniphila(A. muciniphila) and explored the mechanism underlying the therapeutic effects of Roux-en-Y gastric bypass(RYGB) surgery on type 2 diabetes in diabetic Goto-Kakizaki(GK) rats. METHODS: Male diabetic GK rats(n = 12) aged 8 wk were randomly assigned to the surgery group(GK-RYGB) or sham surgery group(GK-Sham)(n = 6 per group), and another 6 male Wistar rats aged 8 wk served as controls(WS-Sham). In the surgery group, RYGB surgery was conducted, and a sham operation was performed in both sham groups. Fasting blood glucose(FBG) levels before and after surgery, fasting levels of serum insulin and serum glucagon-like peptide-1(GLP-1) and levels 30 min after intragastric injection of glucose, and the amount of A. muciniphila in the stool were determined. Insulin and GLP-1 were measured by enzyme-linked immunosorbent assay, and A. muciniphila were detected by fluorescence-based quantitative polymerase chain reaction. RESULTS: The FBG was improved, and serum GLP-1 and insulin increased significantly(P < 0.05) in the GKRYGB group after surgery compared to levels before surgery and to levels in the GK-Sham group. Before surgery, the amounts of A. muciniphila in the GK-RYGB and GK-Sham groups were significantly lower than in the WS-Sham group(P < 0.05). After surgery, the amount of A. muciniphila in the GK-RYGB group increased markedly compared to that before surgery and to that in the GKSham and WS-Sham groups(P < 0.05). In addition, the A.muciniphila amount was positively related to GLP-1(r = 0.86, P < 0.05). CONCLUSION: Our results demonstrated RYGB surgery may increase GLP-1 secretion, elevate serum insulin after intragastric injection of glucose, and improve insulin resistance in diabetic GK rats, thereby contributing to a significant reduction in blood glucose. The increased amount of A. muciniphila after RYGB surgery may be related to elevated GLP-1 secretion.

Circular versus Linear versus Hand-Sewn Gastrojejunostomy in Roux-en-Y-Gastric Bypass: Data Analysis from a Quality Assurance Study of the Surgical Treatment of Obesity in Germany

Background: Since January 12005, the outcomes of bariatric surgeries have been recorded in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg.?Methods: Data are collected in an online data bank. Data collection began in 2005 for the results of Roux-en-Y Gastric Bypass (RYGB). In addition to primary bariatric operations, data regarding the complications and the amelioration of comorbidities have been analyzed. Participation in the quality assurance study is required for all certified centers in Germany.?Results: Roux-en-Y Gastric Bypass is the most popular bariatric operation in Germany. There were 5115 operations performed from 2005 to 2010. A circular anastomosis was performed in 1587 patients, and a linear anastomosis was performed in 2734 patients. In 783 patients the hand-sewn technique was used. The leakage rate for the linear technique is 1.6%, and the leakage rate is 1.2% for circular anastomosis and 1.4% for hand-sewn technique. The overall postoperative complication rate was significantly higher using the circular technique than using the linear or hand-sewn approach.?Conclusion: RYGB is a popular procedure in Germany. The complication rate has decreased since 2005. A comparison of hand sewn versus linear and versus circular anastomosis indicated a higher complication rate in circular gastrojejunal junctions.

Roux-en-Y胃旁路术后胆囊结石内镜下不同取石方式概述

Roux-en-Y胃旁路术(RYGB)后患者发生胆总管结石较为常见。由于患者术后解剖结构的改变,传统的以十二指肠镜为主的内镜下取石术对于患者和医师均是一项巨大的挑战。近年来,随着科技的进步,逐渐发展形成了多种内镜下取石技术,同时为了提高RYGB患者取石成功率,降低并发症发生率,研究者开发了另外途径的内镜逆行胰胆管造影术(ERCP)技术,包括腹腔镜辅助ERCP、经皮辅助假体内镜治疗、超声内镜引导下经胃ERCP和会合导丝辅助ERCP等。鉴于不同内镜下取石术均有不同的优缺点,本文对RYGB后患者不同内镜下取石方式进行了文献回顾,以期为临床医师提供更多的参考帮助。

非离断Roux-en-Y吻合术在远端胃癌根治术后的应用效果

目的 探讨非离断(Uncut)Roux-en-Y吻合术治疗远端胃癌根治(TLD)术后患者的效果。方法 选取我院收治的远端胃癌患者130例,根据不同手术方式分为观察组和对照组,每组65例。两组均行TLD治疗,对照组接受传统Roux-en-Y吻合术治疗,观察组接受Uncut Roux-en-Y吻合术治疗。对比两组患者手术指标、手术前后主观综合营养评估法(SGA)评分、营养指标[铁蛋白(SF)、瘦素(LEP)]、血清二胺氧化酶(DAO)、D-乳酸水平、并发症发生率。结果 术后1个月、3个月,观察组患者SGA评分低于对照组(P<0.05);与对照组相比,观察组术中失血量更少,重建时长、手术耗时、排气时间及恢复半流食时间更短(P<0.05);观察组患者血清SF水平高于对照组,血清LEP水平低于对照组(P<0.05)。术后1d、3d,观察组患者血清DAO、D-乳酸水平低于对照组(P<0.05)。两组并发症发生率比较,P<0.05。结论 应用Uncut Roux-en-Y吻合术治疗TLD术后患者可优化手术指标、促进机体营养状态改善、减少并发症发生率,且对机体肠黏膜屏障功能影响更小。

非离断式Roux-en-Y吻合术在胃癌消化道重建中的应用效果及对胃肠道屏障功能、胆囊收缩功能的影响

目的探讨非离断式Roux-en-Y吻合术在胃癌消化道重建中的应用效果及对胃肠道屏障功能、胆囊收缩功能的影响。方法选取2020年2月至2022年2月收治的40例行胃癌消化道重建手术患者,按照吻合方法不同将其分为对照组和观察组,各20例。对照组采用传统Roux-en-Y吻合术,观察组采用非离断式Roux-en-Y吻合术。比较两组的治疗效果。结果术后1 d,观察组的血浆D-乳酸、二胺氧化酶(DAO)水平均低于对照组(P<0.05)。术后,观察组的双歧杆菌、乳杆菌、拟杆菌数量多于对照组(P<0.05)。术后1 d,观察组的胆囊收缩素水平低于对照组,胆囊容积、胆囊排空率高于对照组(P<0.05)。观察组的并发症总发生率低于对照组(P<0.05)。结论非离断式Roux-en-Y吻合术应用于胃癌消化道重建中有助于改善患者的胃肠道屏障功能、胃肠道微生态平衡及胆囊收缩功能,减少并发症发生。

改良Warren吻合术与Roux-en-Y吻合术在小儿腹腔镜胆总管囊肿术中的临床对照研究

目的比较腹腔镜先天性胆总管囊肿根治术中2种胆肠吻合方式的优劣,为临床选择不同术式提供理论依据。方法回顾性分析兰州大学第二医院2016年7月-2022年4月收治的117例先天性胆总管囊肿患者,按手术方式分为Roux-en-Y吻合组(63例)与改良Warren吻合组(54例)。2组患者均行腹腔镜下胆总管囊肿根治性切除术,肠-肠吻合方式有Roux-en-Y式肠-肠吻合及改良Warren式肠-肠吻合。比较2组患者手术效果、术后效果及术后并发症等指标。结果2组患者手术时间、吻合时间、术后恢复排气排便时间、术后并发肠梗阻及反流性胆管炎方面差异均有统计学意义(P<0.05),而其余指标没有显示明显差异(P>0.05)。结论改良Warren吻合术较Roux-en-Y吻合术,具有手术时间短、吻合快、术后肠功能恢复快、防反流效果好等优点,且操作简便,不切断肠管,保证肠管电生理活动的连续性,适合在基层医院推广。