Calmes J M, Giusti V, Suter M
Department of Surgery, Centre Hospitalier Universitaire Vaudois Lausanne, Switzerland.
Obes Surg. 2005 Mar;15(3):316-22. doi: 10.1381/0960892053576785.
Long-term complications leading to reoperation after primary bariatric surgery are not uncommon. Reoperations are particularly challenging because of tissue scarring and adhesions related to the first operation. Reoperations must address the complication(s) related to the scarring and, at the same time, prevent weight regain that would inevitably occur after simple reversal. Conversion to Roux-en-Y gastric bypass (RYGBP) has repeatedly been demonstrated to be the procedure of choice in most situations. It has traditionally been performed through an open approach. Our aim is to describe our experience with the laparoscopic approach in reoperations to RYGBP over the past 5 years.
All patients undergoing laparoscopic RYGBP as a reoperation were included in this study. Patients with multiple previous operations or patients with band erosion after gastric banding were submitted to laparotomy. Data were collected prospectively.
Between June 1999 and August 2004, 49 patients (44 women, 5 men) underwent laparoscopic reoperative RYGBP. The first operation was gastric banding in 32 and vertical banded gastroplasty in 15. The mean duration of the reoperation was 195 minutes. No conversion to open was necessary. Overall morbidity was 20%, with major complications in 2 patients (4%). Weight loss, or weight maintenance, was satisfactory, with a BMI <35 kg/m2 up to 4 years in close to 75% of the patients.
Laparoscopic RYGBP can be safely performed as a reoperation in selected patients provided that the surgical expertise is available. These procedures are clearly more difficult than primary operations, as reflected by the long operative time. Overall morbidity and mortality, however, are not different. Long-term results regarding weight loss or weight maintenance are highly satisfactory, and comparable to those obtained after laparoscopic RYGBP as a primary operation.
初次减肥手术后导致再次手术的长期并发症并不罕见。由于与首次手术相关的组织瘢痕形成和粘连，再次手术极具挑战性。再次手术必须解决与瘢痕形成相关的并发症，同时防止体重反弹，而单纯的手术逆转后体重反弹是不可避免的。在大多数情况下，转为 Roux - Y 胃旁路术（RYGBP）已被反复证明是首选的手术方式。传统上它是通过开放手术进行的。我们的目的是描述过去 5 年中我们在腹腔镜下将手术转为 RYGBP 的再次手术方面的经验。
本研究纳入了所有接受腹腔镜下 RYGBP 再次手术的患者。有多次既往手术史的患者或胃束带术后束带侵蚀的患者接受剖腹手术。数据前瞻性收集。
1999 年 6 月至 2004 年 8 月期间，49 例患者（44 例女性，5 例男性）接受了腹腔镜下再次手术 RYGBP。首次手术为胃束带术的有 32 例，垂直束带胃成形术的有 15 例。再次手术的平均时长为 195 分钟。无需转为开放手术。总体并发症发生率为 20%，2 例患者（4%）出现严重并发症。体重减轻或维持情况令人满意，近 75%的患者在长达 4 年的时间里体重指数（BMI）<35 kg/m²。
只要具备手术专业技能，腹腔镜下 RYGBP 作为再次手术在特定患者中可以安全实施。这些手术显然比初次手术更困难，这从较长的手术时间可以看出。然而，总体并发症发生率和死亡率并无差异。在体重减轻或维持方面的长期结果非常令人满意，与腹腔镜下 RYGBP 作为初次手术的结果相当。
