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EAES Guidelines for Endoscopic Surgery - part 7

Đã đi hơn nữa trong thử nghiệm của họ khi họ tìm thấy EWL Greater Trong Những bệnh nhân superobese, Ai Nhận được một 250 cm như Trái ngược với một chi Roux 150 cm. Chiều dài của chân tay biliopancreatic WS được giữ tương tự trong tất cả các bệnh nhân. Trong tay thứ hai của thử nghiệm này, 67 bệnh nhân có BMI giữa 40 và 50 Were ngẫu nhiên đến độ dài chi | 10 The EAES Clinical Practice Guidelines on Obesity Surgery 2005 233 60 went even further in their trial when they found greater EWL in those superobese patients who received a 250 cm as opposed to a 150 cm Roux limb. The length of the biliopancreatic limb was kept similar in all patients. In the second part of this trial 67 patients with a BMI between 40 and 50 were randomized to Roux limb lengths of either 75 or 150 cm but here no apparent advantages were noted with one or the other technique 60 Roux limb length therefore should be adapted to match initial BMI in patients with BMI over 50. In 2004 a similar recommendation was given by SAGES Society of American Gastrointestinal Endoscopic Surgeons EL 4 152 . The retrocolic-retrogastric retrocolic-antegastric and antecolic-antegastric routes all seem acceptable for the Roux limb EL 4 4 . Papasavas et al. 257 258 found slightly less stenoses after retrocolic-retrogastric positioning EL 2b while others reported less hernias for the antecolic route EL 2b 163 . The creation of the gastrojejunostomy is a further critical aspect of RYGB because 3-5 of patients may develop stenosis 292 when reviewing the case series on stenoses EL 4 292 stapled anastomoses appear to give better results than the hand-sewn type. This corresponds well to RCT data in gastric cancer patients EL lb 142 300 307 353 . In obese patients there is only a trial with pseudorandomization by alternation EL 2 b 1 where stenosis occurred in ten of 30 handsewn anastomoses and eight of 60 mechanical anastomoses p 0.047 by Fisher s exact test . Laterolateral anastomoses are currently standard and can be created by circular or linear stapling although the latter seems perferable. A preliminary comparison between 21 and 25 mm stapled end-to-end anastomoses found no differences EL lb 331 . Different devices with similar effectiveness are currently in use EL lb 54 . The mesentery defect should be closed in order to avoid internal hernia EL 4 97 154 258 . A .