背景:机械缝合在减少术后并发症方面代表了消化外科的巨大益处。目前,电动订书机的优点正在评估中。
目的:比较机械吻合器与电动吻合器在胃手术中的疗效,分析泄漏率,出血,装订时间,术后并发症。
方法:98例患者接受胃手术,分为三组:腹腔镜袖状胃切除术(LSG)(n=47),Roux-en-Y胃旁路术(LRYGB)(n=30),和腹腔镜远端胃切除术(LDG)(n=21)。61例患者采用了电动订书机。射击的次数,夹子的数量,总射击时间,完成手术的总时间,术后结局记录在特定方案中.
结果:提交给LSG的患者,LRYGB,和LDG记录的完成手术的时间较短,并且使用电动订书机观察到的击发次数较少(p<0.0001)。在提交给LSG的患者中使用的夹子数量没有差异。在使用机械吻合器完成胃空肠造口术的组中,空肠-空肠吻合术,和空肠横切,观察到更长时间的射击时间和完成程序的总时间(p=0.0001)。比较使用的两种设备,未发现术中并发症。在接受LDG的患者组中注意到非常相似的发现。
结论:电动吻合器具有安全性和有效性,如先前的报告所述,并且具有相关性,因为已证实手术总时间较少,没有术中或术后并发症。
BACKGROUND: Mechanic sutures represent an enormous benefit for digestive surgery in decreasing postoperative complications. Currently, the advantages of motorized stapler are under evaluation.
OBJECTIVE: To compare the efficacy of mechanic versus motorized stapler in gastric surgery, analyzing rate of leaks, bleeding, time of stapling, and postoperative complications.
METHODS: Ninety-eight patients were submitted to gastric surgery, divided into three groups: laparoscopic sleeve gastrectomy (LSG) (n=47), Roux-en-Y gastric bypass (LRYGB) (n=30), and laparoscopic distal gastrectomy (LDG) (n=21). Motorized staplers were employed in 61 patients. The number of firings, number of clips, time of total firings, total time to complete the surgery, and postoperative outcome were recorded in a specific protocol.
RESULTS: Patients submitted to LSG, LRYGB, and LDG recorded a shorter time to complete the procedure and a smaller number of firings were observed using motorized stapler (p<0.0001). No differences were identified regarding the number of clips used in patients submitted to LSG. In the group that used mechanic stapler to complete gastrojejunostomy, jejuno-jejuno-anastomosis, and jejunal transection, it was observed more prolonged time of firing and total time for finishing the procedure (p=0.0001). No intraoperative complications were found comparing the two devices used. Very similar findings were noted in the group of patients undergoing LDG.
CONCLUSIONS: The motorized stapler offers safety and efficacy as demonstrated in prior reports and is relevant since less total time of surgical procedure without intraoperative or postoperative complications were confirmed.