Coakley Brian A, Deveney Clifford W, Spight Donn H, Thompson Sarah K, Le David, Jobe Blair A, Wolfe Bruce M, McConnell Donald B, O'Rourke Robert W
Oregon Health and Science University School of Medicine, Portland, Oregon, USA.
Surg Obes Relat Dis. 2008 Sep-Oct;4(5):581-6. doi: 10.1016/j.soard.2007.10.004. Epub 2007 Dec 11.
Revisional bariatric surgery is increasing in frequency, but the morbidity and efficacy have not been well defined. The primary aim of this study was to determine the clinical efficacy with respect to weight loss, and associated morbidity, of revisional bariatric surgery in an academic university hospital bariatric surgery program.
A retrospective review of all patients who underwent revisional bariatric surgery for failed primary restrictive procedures, including gastroplasty and gastric bypass, but not including gastric banding or malabsorptive procedures, during a 10-year period at a single university hospital was performed. The perioperative morbidity and long-term weight loss and clinical results were determined from the medical charts.
A total of 41 patients met the inclusion criteria. The primary bariatric procedures included vertical banded gastroplasty in 20 and Roux-en-Y gastric bypass in 21. The indications for revisional surgery included poor weight loss, weight regain, and various technical problems, including anastomotic stenosis and ulcer. The major morbidity rate was 17%. No patients died. The weight loss results varied depending on the indication for the revisional surgery and reoperative solution applied. The resolution of technical problems was achieved in all patients.
Revisional bariatric surgery can be performed with minimal mortality, albeit significant morbidity. The efficacy with respect to weight loss appeared acceptable, although the results were not as good as those after primary bariatric surgery. The analysis of patient subsets stratified by surgical history and revisional strategy provided important insights into the mechanisms of failure and efficacy of different revisional strategies.
减重手术的翻修手术频率正在增加，但其发病率和疗效尚未得到明确界定。本研究的主要目的是确定在一所大学附属医院的减重手术项目中，翻修减重手术在体重减轻及相关发病率方面的临床疗效。
对一所大学医院在10年期间接受翻修减重手术的所有患者进行回顾性研究，这些患者的初次限制性手术（包括胃成形术和胃旁路手术，但不包括胃束带术或吸收不良手术）失败。从病历中确定围手术期发病率、长期体重减轻情况和临床结果。
共有41例患者符合纳入标准。初次减重手术包括20例垂直束带胃成形术和21例Roux-en-Y胃旁路手术。翻修手术的指征包括体重减轻不佳、体重反弹以及各种技术问题，如吻合口狭窄和溃疡。主要发病率为17%。无患者死亡。体重减轻结果因翻修手术的指征和采用的再次手术解决方案而异。所有患者的技术问题均得到解决。
翻修减重手术可以在死亡率极低的情况下进行，尽管发病率较高。尽管结果不如初次减重手术后的效果，但在体重减轻方面的疗效似乎是可以接受的。根据手术史和翻修策略对患者亚组进行分析，为不同翻修策略的失败机制和疗效提供了重要见解。
