Reusable Retaining Spiral Cross-Type Membrane Valve Trocar for Laparoscopy Instrument

FAQ

Standardized surgical operation guide for laparoscopic single-stomach gastric bypass was released

The "Standardized surgical operation guide for laparoscopic single-stomach gastric bypass (2022 edition)" was initiated and compiled by the Obesity and Diabetes Surgeons Committee (CSMBS) of the Chinese Medical Association's Surgeons Branch and released on October 25, 2022. The guideline aims to standardize the surgical operation of laparoscopic single-stomach gastric bypass (OAGB) to cope with the current situation of the increasing number of patients with metabolic diseases such as obesity and type 2 diabetes in my country.

What are the specific operating steps of laparoscopic single-stomach gastric bypass (OAGB)?

The specific operating steps of laparoscopic single-stomach gastric bypass (OAGB) are as follows:

Body position and puncture site position: The patient adopts the "big" position, the surgeon stands between his thighs, the scope holder stands on the left side of the surgeon, and the assistant stands on the left side of the patient. A 10 mm Trocar was inserted at the umbilicus, a 5 mm Trocar was inserted at the level of the umbilicus at the left midclavicular line, and a 5 mm Trocar was inserted at the level of the umbilicus at the right midclavicular line.

Make a small stomach pouch: First, make a small stomach pouch with a volume of 10 to 30 ml.

Confirm the starting point of the Treitz ligament: Find and confirm the starting point of the Treitz ligament.

Anterior colon anastomosis: Measure 50 to 100 cm of the intestinal tube as the length of the bile and pancreatic branch, cut the small intestine here, and lift the distal small intestine to anastomose the proximal small intestine.

What are the main complications mentioned in the "Standardized Surgical Operation Guidelines for Laparoscopic Single Anastomosis Gastric Bypass (2022 Edition)"?

The main complications mentioned in the "Standardized Surgical Operation Guidelines for Laparoscopic Single Anastomosis Gastric Bypass (2022 Edition)" include leakage, bleeding, deep vein thrombosis, small intestinal obstruction, atelectasis, and puncture hernia.

How to evaluate the recovery of patients after laparoscopic single anastomosis gastric bypass?

The following aspects can be used to evaluate the patient recovery after laparoscopic single-anastomosis gastric bypass surgery:

Complication rate: According to the evidence, the incidence of postoperative complications is 7%, including 4 cases of Clavien-Dindo grade II and above complications, but all of these complications recovered after corresponding treatment. This shows that the incidence of complications is low and most complications can be controlled through proper care and management.

Postoperative pain management: The visual analog scale assessment of pain in laparoscopic surgery on days 1, 3, and 7 after surgery showed significant pain reduction (p < 0.05), which shows that laparoscopic surgery has obvious advantages in postoperative pain management.

Monitoring of nutritional status: After surgery, the nutritional status of patients needs to be closely monitored, especially the monitoring of bone density and blood calcium levels. Simple gastric bypass usually has less bone loss, but patients still need to supplement calcium and vitamin D according to their preoperative conditions.

Impact of programmed care: Programmed care can significantly improve the quality of care and postoperative recovery of patients. Through the cyclic steps of assessment, diagnosis, nursing plan, nursing implementation and nursing evaluation, the specific problems of patients are clarified and targeted nursing content is implemented, which can effectively avoid the shortcomings of conventional nursing methods.

The influence of preoperative nutritional status: Preoperative nutritional status has a significant impact on the quality of early postoperative recovery of elderly patients. The nutritional status of patients is assessed using the Mini-Nutritional Assessment (MNA) score, and corresponding nursing measures are taken according to the scoring results, which can improve the quality of postoperative recovery.

Application of the concept of rapid recovery surgery: The application of the concept of rapid recovery surgery in postoperative recovery includes statistics on operation time, intraoperative blood loss, etc., and analysis of postoperative recovery conditions such as hospitalization time, anal recovery and exhaust time, complications, etc. Using the recovery quality scale QoR-15 to evaluate postoperative recovery is also an effective method.

The evaluation of the recovery of patients after laparoscopic single-anastomosis gastric bypass should comprehensively consider the incidence of complications, postoperative pain management, nutritional status monitoring, the impact of procedural nursing, and the application of preoperative nutritional status and rapid recovery surgery concepts.

What are the advantages and disadvantages of laparoscopic single-anastomosis gastric bypass compared with traditional surgical methods?

Laparoscopic single-anastomosis gastric bypass (OAGB) has the following advantages and disadvantages compared with traditional surgical methods:

Advantages:
Surgery simplification: OAGB simplifies the technical difficulty of Roux-en-Y gastric bypass (RYGB), shortens the operation time, and reduces one anastomosis.

High type 2 diabetes remission rate: Studies have shown that the 5-year remission rate of type 2 diabetes after OAGB is significantly higher than that of RYGB, especially for patients with low body mass index (BMI < 30kg/m²).

Disadvantages:
Risk of bile reflux: Bile reflux may occur after OAGB, increasing the risk of gastric cancer and esophageal cancer, which is one of the main reasons why many doctors are reluctant to adopt this technology.

Lack of standardized guidelines: Although OAGB has been carried out in China for more than 15 years, there is still a lack of relevant standardized surgical operation guidelines or consensus in China.

What are the main challenges in the implementation of the "Standardized Surgical Operation Guidelines for Laparoscopic Single-Anastomosis Gastric Bypass (2022 Edition)"?

The main challenges in the implementation of the "Standardized Surgical Operation Guidelines for Laparoscopic Single-Anastomosis Gastric Bypass (2022 Edition)" include the following aspects:

Technical complexity: Laparoscopic single-anastomosis gastric bypass itself has a high technical difficulty, requiring doctors to have solid laparoscopic surgical skills and rich clinical experience.

Training and education: In order for more doctors to master this technology and follow standardized operations, systematic training and education are required. This includes not only basic laparoscopic surgical skills training, but also detailed explanations of specific operating steps and precautions.

Equipment and technical support: High-quality laparoscopic equipment and related auxiliary tools are the basis for the implementation of this operation. Ensuring that all equipment involved in the operation is in good condition and that doctors are able to use these equipment proficiently is another challenge that needs to be overcome.

Patient management and postoperative care: Postoperative patient management and care are also an important part of the implementation of standardized surgical operation guidelines. How to effectively manage postoperative complications, provide personalized rehabilitation guidance, and ensure smooth postoperative recovery for patients are issues that require special attention.

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