Obesity is a growing problem in developed countries,and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients.Despite the advances in ...Obesity is a growing problem in developed countries,and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients.Despite the advances in surgical techniques,some patients still develop acute and late postoperative complications,and an endoscopic evaluation is often required for diagnosis.Moreover,the high morbidity related to surgical reintervention,the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery,and,in many cases,a suitable first-line treatment of bariatric surgery complications.There is now evidence in the literature supporting endoscopic management for some of these complications,such as gastrointestinal bleeding,stomal and marginal ulcers,stomal stenosis,leaks and fistulas or pancreatobiliary disorders.However,endoscopic treatment in this setting is not standardized,and there is no consensus on its optimal timing.In this article,we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment.Based on a thorough review of the literature,we evaluated the performance and safety of different endoscopic options for every type of complication,highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.展开更多
目的评价腹腔镜与开放肝总管空肠Roux-en-Y吻合术后并发症发生率。方法检索Pub Med、Web of Science、中国知网、维普、万方数据库,收集腹腔镜与开放肝总管空肠Roux-en-Y吻合术后并发症的相关研究,检索时限均为从建库至2016年5月20日,由...目的评价腹腔镜与开放肝总管空肠Roux-en-Y吻合术后并发症发生率。方法检索Pub Med、Web of Science、中国知网、维普、万方数据库,收集腹腔镜与开放肝总管空肠Roux-en-Y吻合术后并发症的相关研究,检索时限均为从建库至2016年5月20日,由2位研究者根据纳入与排除标准独立筛选文献、提取资料和评价质量,采用STATA12.0软件对术后总并发症、切口感染、黏连性肠梗阻和胆漏的发生率进行分析。结果纳入9篇文献共548例患者,腹腔镜组261例,开腹组287例。腹腔镜组与开腹组相比,总并发症发生率低[比值比（OR）=0.40,95%可信区间（95%CI）：0.24-0.68）,P=0.001],切口感染发生率低（OR=0.20,95%CI：0.08-0.53,P=0.001）,黏连性肠梗阻发生率低（OR=0.25,95%CI：0.06-0.99,P=0.049）,差异均有统计学意义;2组间胆漏发生率差异无统计学意义（P〉0.05）。结论腹腔镜肝总管空肠Roux-en-Y吻合术较开放手术可降低术后总并发症、黏连性肠梗阻和切口感染发生率,是安全、可行的手术方式。展开更多
文摘Obesity is a growing problem in developed countries,and surgery is the most effective treatment in terms of weight loss and improving medical comorbidity in a high proportion of obese patients.Despite the advances in surgical techniques,some patients still develop acute and late postoperative complications,and an endoscopic evaluation is often required for diagnosis.Moreover,the high morbidity related to surgical reintervention,the important enhancement of endoscopic procedures and technological innovations introduced in endoscopic equipment have made the endoscopic approach a minimally-invasive alternative to surgery,and,in many cases,a suitable first-line treatment of bariatric surgery complications.There is now evidence in the literature supporting endoscopic management for some of these complications,such as gastrointestinal bleeding,stomal and marginal ulcers,stomal stenosis,leaks and fistulas or pancreatobiliary disorders.However,endoscopic treatment in this setting is not standardized,and there is no consensus on its optimal timing.In this article,we aim to analyze the secondary complications of the most expanded techniques of bariatric surgery with special emphasis on those where more solid evidence exists in favor of the endoscopic treatment.Based on a thorough review of the literature,we evaluated the performance and safety of different endoscopic options for every type of complication,highlighting the most recent innovations and including comparative data with surgical alternatives whenever feasible.
文摘目的评价腹腔镜与开放肝总管空肠Roux-en-Y吻合术后并发症发生率。方法检索Pub Med、Web of Science、中国知网、维普、万方数据库,收集腹腔镜与开放肝总管空肠Roux-en-Y吻合术后并发症的相关研究,检索时限均为从建库至2016年5月20日,由2位研究者根据纳入与排除标准独立筛选文献、提取资料和评价质量,采用STATA12.0软件对术后总并发症、切口感染、黏连性肠梗阻和胆漏的发生率进行分析。结果纳入9篇文献共548例患者,腹腔镜组261例,开腹组287例。腹腔镜组与开腹组相比,总并发症发生率低[比值比（OR）=0.40,95%可信区间（95%CI）：0.24-0.68）,P=0.001],切口感染发生率低（OR=0.20,95%CI：0.08-0.53,P=0.001）,黏连性肠梗阻发生率低（OR=0.25,95%CI：0.06-0.99,P=0.049）,差异均有统计学意义;2组间胆漏发生率差异无统计学意义（P〉0.05）。结论腹腔镜肝总管空肠Roux-en-Y吻合术较开放手术可降低术后总并发症、黏连性肠梗阻和切口感染发生率,是安全、可行的手术方式。
