Zusammenfassung
Hintergrund
Empfehlungen zur Anwendung bestimmter Anastomosentechniken liegen in der laparoskopischen bariatrischen Chirurgie nicht vor. Empfehlungskriterien sollten die Raten an Insuffizienzen, Blutungen, die Neigung zur Striktur oder Ulzeration wie auch den Einfluss auf die Gewichtsabnahme oder Dumping berücksichtigen.
Fragestellung
Es soll eine Übersicht über die vorliegende Evidenz bezüglich Anastomosentechniken typischer Operationsverfahren in der laparoskopischen bariatrischen Chirurgie gegeben werden.
Material und Methoden
Es erfolgte eine Auswertung und Diskussion der aktuellen Literatur bezüglich Techniken der Anastomosierung beim Roux-en-Y-Magenbypass (RYGB), beim One-anastomosis-gastric-Bypass (OAGB), beim Single-anastomosis-sleeve-ileal-Bypass (SASI) und bei der biliopankreatischen Diversion mit duodenalem Switch (BPD-DS).
Ergebnisse
Es existieren, bis auf den RYGB, wenig komparative Studien. Bei der Gastrojejunostomie des RYGB zeigte sich die komplette Handnaht der mechanischen Anastomose ebenbürtig. Zudem zeigten sich leicht Vorteile der linearen Klammernaht gegenüber dem Zirkularstapler in Bezug auf Wundinfektionen und Blutungen. Die Anastomosentechnik des OAGB und SASI kann vollständig mit Linearstapler oder mit Nahtverschluss des Vorderwanddefekts erfolgen. Bei der BPD-DS scheint es einen Vorteil der Handanastomose zu geben.
Schlussfolgerungen
Aufgrund der fehlenden Evidenz können keine Empfehlungen gegeben werden. Lediglich beim RYGB zeigte sich ein Vorteil der linearen Staplertechnik mit Handverschluss des Staplerdefekts gegenüber dem Linearstapler. Prinzipiell sind prospektive, randomisierte Studien anzustreben.
Abstract
Background
Recommendations for the use of specific anastomotic techniques are not available in laparoscopic bariatric surgery. Recommendation criteria should consider the rate of insufficiency, bleeding, tendency to stricture or ulceration as well as the impact on weight loss or dumping.
Objective
This article gives a review of the available evidence on the anastomotic techniques of typical surgical procedures in laparoscopic bariatric surgery.
Material and methods
The current literature was reviewed and is discussed regarding anastomotic techniques for Roux-en‑Y gastric bypass (RYGB), one-anastomosis gastric bypass (OAGB), single anastomosis sleeve ileal (SASI) bypass and biliopancreatic diversion with duodenal switch (BPD-DS).
Results
Few comparative studies exist, except for the RYGB. In RYGB gastrojejunostomy, a complete manual suture was shown to be equivalent to a mechanical anastomosis. In addition, the linear staple suture showed slight advantages over the circular stapler in terms of wound infections and bleeding. The anastomosis technique of the OAGB and SASI can be performed entirely with a linear stapler or with suture closure of the anterior wall defect. There seems to be an advantage of manual anastomosis in BPD-DS.
Conclusion
Due to the lack of evidence, no recommendations can be made. Only in RYGB was there an advantage of the linear stapler technique with hand closure of the stapler defect compared to the linear stapler. In principle, prospective, randomized studies should be strived for.
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U.G. Lange, M. Mehdorn und A. Dietrich geben an, dass kein Interessenkonflikt besteht.
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Lange, U.G., Mehdorn, M. & Dietrich, A. Anastomosentechniken in der minimal-invasiven bariatrischen Chirurgie. Chirurgie 94, 768–774 (2023). https://doi.org/10.1007/s00104-023-01907-9
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DOI: https://doi.org/10.1007/s00104-023-01907-9
Schlüsselwörter
- Roux-en-Y-Magenbypass
- Ein-Anastomosen-Magenbypass
- Ein-Anastomosen-Sleeve-Ileum-Bypass
- Biliopankreatische Diversion mit duodenalem Switch
- Lineare Staplertechnik