Gumbs Andrew A, Pomp Alfons, Gagner Michel
New York-Presbyterian Hospital, Division of Laparoscopy and Department of Surgery, Weill-Cornell College of Medicine, New York, NY 10021, USA.
Obes Surg. 2007 Sep;17(9):1137-45. doi: 10.1007/s11695-007-9209-9.
When behavioral or anatomic issues are not present, revisional surgery should be approached with a goal of treating malnutrition or enhancing excess weight loss. Unfortunately, no randomized controlled trials currently exist to help the practicing bariatric surgeon choose which revisional procedure to perform. A review of the available literature was undertaken and compared with our standard practices to see if any guidelines could be devised. At our institution, patients who have failed jejunal-ileal bypass are reversed in the setting of malnutrition and converted to a sleeve gastrectomy (SG) followed by duodenal switch (DS) as a second stage procedure in the setting of inadequate weight loss. After failed vertical banded gastroplasty (VBG), patients are converted to a Roux-en-Y gastric bypass (RYGBP). After failed adjustable gastric band (AGB) placement, we perform RYGBP. In the super-obese, we leave the band in place or convert to a DS with band removal. In patients with failed RYGBP, we convert our patients to DS, but placement of an AGB may be an acceptable option.
当不存在行为或解剖学问题时，翻修手术应以治疗营养不良或促进体重过度减轻为目标。不幸的是，目前尚无随机对照试验可帮助执业减重外科医生选择进行哪种翻修手术。我们对现有文献进行了回顾，并与我们的标准做法进行了比较，以确定是否可以制定任何指南。在我们机构，空肠-回肠旁路手术失败的患者在出现营养不良时进行逆转，并转换为袖状胃切除术（SG），然后在减重不足的情况下作为第二阶段手术进行十二指肠转位术（DS）。垂直束带胃成形术（VBG）失败后，患者转换为Roux-en-Y胃旁路术（RYGBP）。可调式胃束带（AGB）放置失败后，我们进行RYGBP。对于超级肥胖患者，我们保留束带或将其转换为切除束带的DS。RYGBP失败的患者，我们将其转换为DS，但放置AGB可能是一个可接受的选择。
