当天出院的吻合代谢和减肥手术:来自加拿大一个高流量中心的一组患者的 30 天疗效

IF 3.5 3区 医学 Q1 SURGERY Surgery for Obesity and Related Diseases Pub Date : 2024-08-16 DOI:10.1016/j.soard.2024.08.020
Alexis Deffain M.D., Ronald Denis M.D., Heba Alfaris M.D., Karim Ataya M.D., Samah Melebari M.D., Marc Belliveau M.D., Adam Di Palma M.D., Pierre Garneau M.D., Anne-Sophie Studer M.D.
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引用次数: 0

摘要

基于我们在当天出院(SDD)袖状胃切除术中积累的丰富经验,我们将这一管理策略推广到了吻合口代谢和减肥手术(MBS)中。回顾性分析吻合口 MBS 术后早期(≤30 天)的疗效,并计划 SDD(≤12 小时)。加拿大大学医院;公共实践。SDD吻合器MBS的提出有严格的术前标准,包括单吻合十二指肠-回肠旁路袖带胃切除术(SADI-S)、Roux-en-Y胃旁路术(RYGB)、单吻合胃旁路术(OAGB)和单吻合袖带回肠旁路术(SASI)。遵循减肥手术后强化恢复方案和麻醉后护理病房标准。对计划外过夜、急诊科就诊、再入院、发病率-死亡率和再干预率进行了分析。自 2021 年以来,共有 208 名患者(191 名女性和 17 名男性)接受了 SDD 吻合器 MBS,其中 76% 接受了转换手术:92 例 SADI-S、72 例 RYGB、35 例 OAGB 和 9 例 SASI(平均年龄 = 41.4 岁,术前平均体重指数 = 41.9 kg/m)。计划外过夜率和急诊就诊率分别为 4.8% 和 4.3%。再入院率为 5.8%(5 例 SADI-S、5 例 RYGB、1 例 OAGB 和 1 例 SASI)。总发病率为 14.9%,包括 3.9% 的主要并发症。术后 30 天内,SADI-S 组有 2 例十二指肠漏、1 例腹腔积液、1 例总胆管狭窄和 1 例急性阑尾炎。RYGB 组有 2 例空肠吻合口闭塞,1 例胃空肠吻合口出血。5例(2.4%)需要再次手术,无死亡病例。我们的报告显示,计划外过夜、再次入院和再次手术的发生率较低且可以接受。早期结果表明,只要有经验丰富的团队、选择性标准和适当的术后随访,SDD 吻合器 MBS 似乎是安全可行的。
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Anastomotic metabolic and bariatric surgeries with same-day discharge: 30-day outcomes of a cohort from a high-volume center in Canada
On the basis of our extensive experience in same-day discharge (SDD) sleeve gastrectomy, we extended this management strategy to anastomotic metabolic and bariatric surgeries (MBS). To retrospectively analyze early outcomes (≤30 d) after anastomotic MBS with planned SDD (≤12 hr). University Hospital, Canada; Public Practice. SDD anastomotic MBS were proposed with strict preoperative criteria and included single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S), Roux-en-Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), and single-anastomosis sleeve ileal bypass (SASI). Enhanced recovery after bariatric surgery protocols and post-anesthesia care unit criteria were followed. Unplanned overnight stay, emergency department (ED) visit, readmission, morbidity-mortality, and reintervention rates were analyzed. Since 2021, 208 patients (191 female and 17 male) have undergone SDD anastomotic MBS, with 76% conversion procedures: 92 SADI-S, 72 RYGB, 35 OAGB, and 9 SASI (mean age = 41.4 yr and mean preoperative body mass index = 41.9 kg/m). Unplanned overnight stays and ED visits were 4.8% and 4.3%, respectively. Readmission rate was 5.8% (5 SADI-S, 5 RYGB, 1 OAGB, and 1 SASI). Overall morbidity rate was 14.9%, including 3.9% major complications. Within 30 days postoperatively, there were 2 duodenal leaks, 1 intrabdominal collection, 1 common bile duct stenosis, and 1 acute appendicitis in the SADI-S group. There were 2 occlusions on the jejunojejunal anastomosis and 1 bleeding on the gastrojejunal anastomosis in the RYGB group. Five (2.4%) required reintervention with no mortality. We report low and acceptable rates of unplanned overnight stay, readmission, and reintervention. Early outcomes suggest that SDD anastomotic MBS seems safe and feasible with an experienced team, selective criteria, and appropriate postoperative follow-up.
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来源期刊
CiteScore
6.70
自引率
12.90%
发文量
570
审稿时长
56 days
期刊介绍: Surgery for Obesity and Related Diseases (SOARD), The Official Journal of the American Society for Metabolic and Bariatric Surgery (ASMBS) and the Brazilian Society for Bariatric Surgery, is an international journal devoted to the publication of peer-reviewed manuscripts of the highest quality with objective data regarding techniques for the treatment of severe obesity. Articles document the effects of surgically induced weight loss on obesity physiological, psychiatric and social co-morbidities.
期刊最新文献
Editorial Board Table of Contents SOARD Category 1 CME Credit Featured Articles, Volume 20, November 2024 Cartoon Editorial Board
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