Kaminski D L
Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO 63110-0250, USA.
Int J Surg Investig. 2001;2(5):413-21.
Bariatric surgery has included a large number of operative procedures, some of which have become extinct and others, such as gastric restrictive procedures, which continue to be performed. While these operative procedures play an important role in the management of obesity, they are associated with significant failure rates. This study was performed to evaluate the results of operations performed on patients to revise failed gastric restrictive procedures.
During the past 15 years operative revision of gastric restrictive procedures was performed on 65 patients. The demographic, operative, and postoperative information has been prospectively collected. The patients were divided into 20 non-obese patients who weighed less than 250 pounds (range 90-247 pounds) and 45 obese patients weighing more than 250 pounds (range 256-527 pounds). The primary indications for operation on the non-obese patients were intragastric foreign body, gastric fistula, gastroesophageal reflux, and non emptying gastric pouch. The obese patients underwent revision for gastroesophageal reflux and failure to maintain weight loss. The obese patients frequently had obesity associated health problems including sleep apnea (N = 5), hypertension (N = 6), diabetes (N = 5) and ventral hernia (N = 30). The operative procedures in the non-obese patients consisted of revision of a gastroplasty in two patients, conversion of a gastroplasty to a gastric bypass in 12 patients and revision of a gastric bypass in eight patients. In the obese patient group, eight patients underwent revision of a gastroplasty, 19 patients had a gastroplasty converted to a gastric bypass and 14 patients underwent revision of a gastric bypass. The mean +/- SEM length of follow-up was 57 +/- 8 months.
There were two postoperative deaths, one from a pulmonary embolus and one from unknown cause. There was no significant difference regarding the results of the various operations to revise gastric restrictive procedures on the weight of the non-obese patients at long-term follow-up. When obese patients underwent revision of a gastric bypass procedure, they lost 69 +/- 9 pounds which was significantly less than the 82 +/- 12 pounds lost by the patients who underwent revision of a gastroplasty. Conversion of gastroplasty operations to gastric bypass operations in obese patients resulted in the loss of 110 +/- 7 pounds at long-term follow-up.
Revision of gastric restrictive procedures can be performed with durable control of obesity; however, revision of gastric bypass restrictive procedures in obese patients produced the least benefit.
减肥手术包含大量手术方式，其中一些已不再使用，而其他一些，如胃限制性手术，仍在开展。虽然这些手术方式在肥胖管理中发挥着重要作用，但它们的失败率也很高。本研究旨在评估对接受失败的胃限制性手术患者进行再次手术的结果。
在过去15年中，对65例患者进行了胃限制性手术的再次手术。前瞻性收集了患者的人口统计学、手术及术后信息。患者分为20例体重小于250磅（90 - 247磅）的非肥胖患者和45例体重超过250磅（256 - 527磅）的肥胖患者。非肥胖患者手术的主要适应证为胃内异物、胃瘘、胃食管反流和胃袋排空障碍。肥胖患者因胃食管反流和体重减轻维持失败而接受再次手术。肥胖患者常伴有肥胖相关的健康问题，包括睡眠呼吸暂停（N = 5）、高血压（N = 6）、糖尿病（N = 5）和腹疝（N = 30）。非肥胖患者的手术方式包括2例胃成形术的修复、12例胃成形术转为胃旁路手术以及8例胃旁路手术的修复。在肥胖患者组中，8例患者接受了胃成形术的修复，19例患者将胃成形术转为胃旁路手术，14例患者接受了胃旁路手术的修复。平均随访时间±标准误为57±8个月。
术后有2例死亡，1例死于肺栓塞，1例死因不明。在长期随访中，对非肥胖患者进行各种胃限制性手术修复的结果在体重方面无显著差异。肥胖患者接受胃旁路手术修复时，体重减轻了69±9磅，明显少于接受胃成形术修复的患者减轻的82±12磅。肥胖患者将胃成形术转为胃旁路手术在长期随访中体重减轻了110±7磅。
胃限制性手术的修复可以持久控制肥胖；然而，肥胖患者胃旁路限制性手术的修复获益最少。
