Di Betta Ernesto, Mittempergher Francesco, Di Fabio Francesco, Casella Claudio, Terraroli Carmen, Salerni Bruno
Department of General Surgery, University of Brescia School of Medicine, Brescia, Italy.
Obes Surg. 2006 Mar;16(3):258-61. doi: 10.1381/096089206776116480.
Several surgical treatments have been proposed for patients in whom gastric restrictive operations have failed. The aim of this study was to analyze the effectiveness and safety of duodenal switch (DS) with restoration of normal gastric capacity in such patients.
Between May 2001 and May 2003, 11 DS with restoration of normal gastric capacity were performed without other gastric procedures in patients who had had previous gastric restrictive operations which had failed because of inadequate weight loss or weight regain. Data were collected and follow-up was 2 years for all patients.
At the original operation, mean BMI was 47.3 (range 38-53) kg/m2, and mean age was 42 years. 7 of the 11 patients (63.6%) had previous vertical banded gastroplasty, and 4 of the 11 (36.4%) had previous laparoscopic adjustable gastric banding. Mean percentage weight regain and mean BMI at the time of DS were 92.1% and 44.6 (range 35-53) kg/m2 respectively. After the second operation, mean BMI at 6 months was 35.4 kg/m2, at 12 months 31.7 kg/m2 and at 24 months 28.6 kg/m2. The % excess weight loss was 41.1 after 6 months, 56.6 after 12 months and 69.6 after 2 years. There was minor morbidity and no mortality.
After this experience, we suggest that patients with failed gastric restrictive operations (weight regain or inadequate weight loss) may undergo DS with restoration of normal gastric capacity. This second operation proved to be safe and effective.
对于胃限制性手术失败的患者，已提出多种手术治疗方法。本研究的目的是分析十二指肠转位术（DS）恢复正常胃容量对此类患者的有效性和安全性。
在2001年5月至2003年5月期间，对11例因减重不足或体重反弹导致先前胃限制性手术失败的患者进行了11次恢复正常胃容量的DS手术，未进行其他胃部手术。收集了所有患者的数据并进行了2年的随访。
初次手术时，平均体重指数（BMI）为47.3（范围38 - 53）kg/m²，平均年龄为42岁。11例患者中有7例（63.6%）曾接受过垂直捆绑胃成形术，11例中有4例（36.4%）曾接受过腹腔镜可调节胃束带术。DS手术时的平均体重反弹百分比和平均BMI分别为92.1%和44.6（范围35 - 53）kg/m²。二次手术后，6个月时平均BMI为35.4 kg/m²，12个月时为31.7 kg/m²，24个月时为28.6 kg/m²。6个月时超重体重减轻百分比为41.1%，12个月时为56.6%，2年后为69.6%。并发症轻微，无死亡病例。
基于此次经验，我们建议胃限制性手术失败（体重反弹或减重不足）的患者可接受恢复正常胃容量的DS手术。该二次手术被证明是安全有效的。
