Bessler Marc, Daud Amna, DiGiorgi Mary F, Olivero-Rivera Lorraine, Davis Daniel
Center for Obesity Surgery, Columbia University, New York-Presbyterian Hospital, New York, NY 10032, USA.
Obes Surg. 2005 Nov-Dec;15(10):1443-8. doi: 10.1381/096089205774859173.
Inadequate weight loss after proximal gastric bypass presents a clinical challenge to bariatric surgeons. Pouch size, stoma size and limb length are the variables that can be surgically altered. Aside from conversion to distal bypass, which may have significant negative nutritional sequelae, revisional surgery for this group of patients has not often been reported. The addition of adjustable silicone gastric banding (ASGB) to Roux-en-Y gastric bypass (RYGBP) may be a useful revision strategy because it has potential safety benefits over other revisional approaches.
We report on 8 patients who presented with inadequate weight loss or significant weight regain after proximal gastric bypass. All patients underwent revision with the placement of an ASGB around the proximal gastric pouch. Bands were adjusted at 6 weeks postoperatively and beyond as needed. Complications and weight loss at the most recent follow-up visit were evaluated.
Mean age and body mass index (BMI) at the time of revision were 39 +/- 9.9 years and 44.0 +/- 4.5 kg/m2 respectively. No patients were lost to follow-up, and they lost an average of 38.1 +/- 10.4% and 44.0 +/- 36.3% of excess weight and 49.1 +/- 20.9% and 52.0 +/- 46.0% of excess BMI in 12 and 24 months respectively. Patients lost an average of 62.0 +/- 20.5% of excess weight from the combined surgeries in 67 (48-84) months. The only complication was the development of a seroma overlying the area of the port adjustment in one patient. There have been no erosions or band slippages to date.
These results indicate that the addition of an ASGB causes significant weight loss in patients with poor weight loss outcome after RYGBP. The fact that no anastomosis or change in absorption is required may make this an attractive revisional strategy. Long- term evaluation in a larger population is warranted.
近端胃旁路术后体重减轻不足给减重外科医生带来了临床挑战。胃囊大小、吻合口大小和肠袢长度是可以通过手术改变的变量。除了转换为远端旁路手术（这可能会有显著的负面营养后遗症）外，针对这类患者的翻修手术鲜有报道。在Roux-en-Y胃旁路术（RYGBP）基础上加用可调节硅胶胃束带（ASGB）可能是一种有用的翻修策略，因为与其他翻修方法相比，它具有潜在的安全性优势。
我们报告了8例近端胃旁路术后体重减轻不足或体重显著反弹的患者。所有患者均接受了在近端胃囊周围放置ASGB的翻修手术。术后6周及以后根据需要对束带进行调整。评估了最近一次随访时的并发症和体重减轻情况。
翻修时的平均年龄和体重指数（BMI）分别为39±9.9岁和44.0±4.5kg/m²。无患者失访，他们在12个月和24个月时分别平均减轻了超重部分的38.1±10.4%和44.0±36.3%，以及超重BMI的49.1±20.9%和52.0±46.0%。在67（48 - 84）个月内，患者通过联合手术平均减轻了超重部分的62.0±20.5%。唯一的并发症是1例患者在端口调整区域出现了血清肿。迄今为止，未发生侵蚀或束带滑脱。
这些结果表明，加用ASGB可使RYGBP术后体重减轻不佳的患者显著减重。无需进行吻合或改变吸收这一事实可能使这成为一种有吸引力的翻修策略。有必要在更大规模人群中进行长期评估。
