Laparoscopic Sleeve Gastrectomy plus Duodenojejunal Bypass: Learning Curve Analysis and Technical Feasibility of Duodenojejunostomy Using Linear Stapler,Obesity Surgery

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Laparoscopic Sleeve Gastrectomy plus Duodenojejunal Bypass: Learning Curve Analysis and Technical Feasibility of Duodenojejunostomy Using Linear Stapler
Obesity Surgery ( IF 2.9 ) Pub Date : 2023-11-20 , DOI: 10.1007/s11695-023-06940-5
Dongjae Jeon ₁ , Yoona Chung ₁ , Bomina Paik ₁ , Yong Jin Kim ₁

Affiliation

Introduction

Laparoscopic sleeve gastrectomy plus duodenojejunal bypass (LSG-DJB) has emerged as an alternative bypass surgery. Despite its potential benefits, the technical challenges of the procedure have limited its adoption. This study aims to present the learning curve for LSG-DJB and explore potentially beneficial technical modifications for the standardization of the procedure.

Methods

The study retrospectively analyzed 100 patients who underwent LSG-DJB as a primary procedure from July 2014 through September 2021. Baseline characteristics, weight loss outcomes, remission of metabolic diseases, and perioperative complications were assessed. The operative time was analyzed across both time trends and anastomosis type subgroups.

Results

At 1-year follow-up after LSG-DJB, the mean %total weight loss and the mean BMI loss were 25.38 ± 8.58% and 9.38 ± 4.25 kg/m2, respectively. Remission rates for type 2 diabetes, hypertension, and dyslipidemia were 72.0% (67/93), 84.1% (37/44), and 70.3% (52/74), respectively. In the analysis of operative time, the learning curve exhibited a plateau after 25 cases. The mean operative time was 136.00 ± 21.64 min in the stapled anastomosis group, and 150.62 ± 25.42 min in the hand-sewn anastomosis group.

Conclusion

The learning curve for LSG-DJB plateaued after 25 cases. In the LSG-DJB procedure, stapled duodenojejunal anastomosis is feasible and achieves similar outcomes to the hand-sewn method.

Graphical Abstract

中文翻译：

腹腔镜袖状胃切除术加十二指肠空肠旁路术：线性吻合器十二指肠空肠吻合术的学习曲线分析和技术可行性

介绍

腹腔镜袖状胃切除术加十二指肠空肠搭桥术（LSG-DJB）已成为替代搭桥手术。尽管有潜在的好处，但该程序的技术挑战限制了其采用。本研究旨在展示 LSG-DJB 的学习曲线，并探索对程序标准化可能有益的技术修改。

方法

该研究回顾性分析了 2014 年 7 月至 2021 年 9 月期间接受 LSG-DJB 作为主要手术的 100 名患者。评估了基线特征、体重减轻结果、代谢性疾病的缓解和围手术期并发症。对时间趋势和吻合类型亚组的手术时间进行了分析。

结果

LSG-DJB 后 1 年随访时，平均总体重减轻百分比和平均 BMI 减轻分别为 25.38 ± 8.58% 和 9.38 ± 4.25 kg/m2。 2型糖尿病、高血压和血脂异常的缓解率分别为72.0%（67/93）、84.1%（37/44）和70.3%（52/74）。在手术时间分析中，学习曲线在 25 例后呈现平台期。吻合器吻合组的平均手术时间为136.00±21.64分钟，手缝吻合组的平均手术时间为150.62±25.42分钟。