Topart Philippe, Becouarn Guillaume, Ritz Patrick
Société de Chirurgie Viscérale, Clinique de l'Anjou, Angers, France.
Surg Obes Relat Dis. 2007 Sep-Oct;3(5):521-5. doi: 10.1016/j.soard.2007.07.001.
Of patients who have undergone gastric banding, 11-25% will require a major reoperation with band removal and conversion to another bariatric procedure after they have failed to lose sufficient weight or have developed dysphagia or reflux. The aim of this study was to evaluate the respective benefits of Roux-en-Y gastric band (RYGB) or biliopancreatic diversion with duodenal switch (BPD-DS) after failed gastric banding and whether 1 of the 2 procedures might be a better procedure for such cases.
RYGB or BPD-DS was performed according to the institutional protocols with synchronous band removal, irrespective of the reason for failure.
Of the 53 patients, 32 underwent laparoscopic RYGB for a body mass index (BMI) of 43.1 +/- 6.4 kg/m(2) (BMI 45.8 +/- 6.4 kg/m(2) before laparoscopic adjustable gastric banding) and 21 underwent BPD-DS for a BMI of 46.0 +/- 5.5 kg/m(2) (BMI 49.6 +/- 5.2 kg/m(2) before laparoscopic adjustable gastric banding). BPD-DS required significantly longer operative times (239.7 +/- 55.8 versus 135 +/- 26.7 minutes) and resulted in more complications (62% versus 12.5%; P <.002). No patients died postoperatively. The 2 groups of patients had a similar BMI at 12 and 18 months after revision (BMI 33.4 +/- 5.6 kg/m(2) and 31.4 +/- 3.5 kg/m(2)). The weight loss was greater after BPD-DS than after RYGB compared with the prerevision weight loss (66.2% versus 58.8% excess weight loss) or initial weight (73% versus 61.8%), although this was not significant.
Despite an excessive rate of complications that were, in part, related to the learning curve in this series, BPD-DS resulted in greater weight loss compared with RYGB. However, both procedures were successful after failed gastric banding. A more accurate definition of failure could help to determine the respective indications for revisional surgery.
在接受胃束带手术的患者中，11% - 25%在未能充分减重或出现吞咽困难或反流后，需要进行移除束带并转换为另一种减肥手术的大型再次手术。本研究的目的是评估胃束带手术失败后，Roux - en - Y胃旁路术（RYGB）或胆胰转流十二指肠转位术（BPD - DS）各自的益处，以及这两种手术中的一种是否对此类病例是更好的手术方式。
根据机构方案进行RYGB或BPD - DS手术，并同步移除束带，无论失败原因如何。
53例患者中，32例接受了腹腔镜RYGB手术，其体重指数（BMI）为43.1±6.4kg/m²（腹腔镜可调节胃束带手术前BMI为45.8±6.4kg/m²），21例接受了BPD - DS手术，其BMI为46.0±5.5kg/m²（腹腔镜可调节胃束带手术前BMI为49.6±5.2kg/m²）。BPD - DS手术所需的手术时间明显更长（239.7±55.8分钟对135±26.7分钟），且导致更多并发症（62%对12.5%；P <.002）。术后无患者死亡。两组患者在翻修术后12个月和18个月时的BMI相似（BMI分别为33.4±5.6kg/m²和31.4±3.5kg/m²）。与翻修术前体重减轻情况（超重减轻66.2%对58.8%）或初始体重相比（73%对61.8%），BPD - DS术后的体重减轻幅度大于RYGB术后，尽管差异不显著。
尽管本系列中并发症发生率过高，部分与学习曲线有关，但与RYGB相比，BPD - DS导致了更大幅度的体重减轻。然而，胃束带手术失败后，这两种手术均取得了成功。对失败的更准确定义有助于确定翻修手术的各自适应症。
