Johnson William H, Fernanadez Adolfo Z, Farrell Timothy M, Macdonald Kenneth G, Grant John P, McMahon Ross L, Pryor Aurora D, Wolfe Luke G, DeMaria Eric J
Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
Surg Obes Relat Dis. 2007 Jan-Feb;3(1):37-41. doi: 10.1016/j.soard.2006.09.012. Epub 2006 Dec 27.
The claim that the "mini"-gastric bypass (MGB) procedure with its loop gastrojejunostomy is safer and equally effective to the Roux-en-Y gastric bypass (RYGB) procedure has been promoted before validation. Rumors of unreported complications and the accuracy of follow-up are additional concerns. This study was undertaken to identify MGB patients who require or required revisional surgery at 5 hospitals within the region of the United States where the MGB procedure originated to assess the claim that revision to RYGB is rarely needed.
The databases of 5 medical centers were retrospectively searched to identify patients undergoing surgical revision after a MGB procedure, all of which had been done elsewhere.
A total of 32 patients were identified who presented with complications after undergoing an MGB procedure and required or require revisional surgery. The complications included gastrojejunostomy leak in 3, bile reflux in 20, intractable marginal ulcer in 5, malabsorption/malnutrition in 8, and weight gain in 2. Of the 32 patients, 21 required conversion to RYGB and an additional 5 have planned revisions in the future. Also, 2 patients were treated with Braun enteroenterostomies and 4 required 1 or more abdominal explorations.
The results of this preliminary review have confirmed that MGB does require revision in some patients and that conversion to RYGB is a common form of revision. A national registry to record the complications and number of revisions is proposed to gain insight into the need for revision after MGB and other nontraditional bariatric procedures.
“迷你”胃旁路术（MGB）及其袢式胃空肠吻合术比 Roux-en-Y 胃旁路术（RYGB）更安全且疗效相当的说法在得到验证之前就已被宣扬。有关未报告并发症的传闻以及随访的准确性是另外令人担忧的问题。本研究旨在确定在美国 MGB 手术起源地区的 5 家医院中需要或曾需要翻修手术的 MGB 患者，以评估很少需要翻修为 RYGB 的说法。
对 5 个医疗中心的数据库进行回顾性检索，以确定在其他地方进行 MGB 手术后接受手术翻修的患者。
共确定了 32 例患者，这些患者在接受 MGB 手术后出现并发症，需要或仍需要翻修手术。并发症包括 3 例胃空肠吻合口漏、20 例胆汁反流、5 例顽固性边缘溃疡、8 例吸收不良/营养不良和 2 例体重增加。在这 32 例患者中，21 例需要转为 RYGB，另外 5 例计划在未来进行翻修。此外，2 例患者接受了 Braun 肠肠吻合术治疗，4 例需要 1 次或更多次腹部探查。
这项初步综述的结果证实，MGB 在一些患者中确实需要翻修，且转为 RYGB 是常见的翻修形式。建议建立一个全国性登记处来记录并发症和翻修次数，以深入了解 MGB 和其他非传统减肥手术术后的翻修需求。
