Dapri Giovanni, Cadière Guy Bernard, Himpens Jacques
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, 322 rue Haute, 1000, Brussels, Belgium.
Obes Surg. 2009 May;19(5):650-4. doi: 10.1007/s11695-009-9807-9. Epub 2009 Mar 5.
Roux-en-Y gastric bypass (RYGBP) is presently one of the most popular surgical procedures for obesity. One of the possible long-term problems is weight regain, usually after a period of successful weight loss. Weight regain after RYGBP can be due to new eating habits, like sweet-eating or grazing, or volume eating because of impaired restriction. This paper reports our experience in patients who presented weight regain after laparoscopic RYGBP, because of new appearance of volume eating or hyperphagia, treated by the laparoscopic placement of a non-adjustable silicone ring around the gastric pouch.
From July 2004 to November 2007, six patients affected by weight regain due to hyperphagic behavior, benefited from revision of RYGBP consisting of the placement of a non-adjustable silicone ring loosely encircling the stomach part. Mean weight and body mass index (BMI) at the time of RYGBP were 105.0 kg +/- 12.3 and 36.3 +/- 3.0 kg/m(2), respectively, and all patients suffered from obesity-related co-morbidities. After a mean time from RYGBP of 26.0 +/- 14.2 months, patients presented a weight regain of 4.7 +/- 3.4 kg compared with their minimal weight, with a final mean weight, BMI, and percentage of excess weight loss (%EWL) at the time of the silicone ring of 86.0 +/- 13.1 kg, 29.5 +/- 3.9 kg/m(2), and 47.0 +/- 24.7%, respectively. Preoperative evaluation for each patient included history and physical examination, nutritional and psychiatric evaluation, laboratory tests, and barium swallow check. Outcome measures included evaluation of the Roux-en-Y construction, operative time, postoperative morbidity and mortality, and weight loss in terms of absolute weight loss, BMI, and %EWL.
Any modification of the digestive circuit was evidenced. Mean operative time was 82.5 +/- 18.3 min. No operative mortality and no conversion to open surgery were achieved. No postoperative complications were achieved. Mean hospital stay was 2.6 +/- 1.5 days. After a mean follow-up of 14.0 +/- 9.2 months, the six patients presented a mean weight loss of 9.1 +/- 2.4 kg, with a final mean weight, BMI, and %EWL of 76.8 +/- 13.7 kg, 26.4 +/- 4.2 kg/m(2), and 70.4 +/- 30.4%, respectively. Difference in term of %EWL before and after revision (23.4 +/- 5.7) is statistically significant (p < 0.05). There have been no erosions or slippage of the ring during this follow-up.
One of the possible causes of weight regain after RYGBP is the new eating behavior of the patient, one of which is hyperphagia. Treatment of this condition can be the placement of a non-adjustable silicone ring loosely fitted around the gastric pouch which contributes to improved weight loss.
Roux-en-Y胃旁路术（RYGBP）目前是治疗肥胖症最常用的外科手术之一。一个可能的长期问题是体重反弹，通常发生在一段成功减重期之后。RYGBP术后体重反弹可能归因于新的饮食习惯，如爱吃甜食或少食多餐，或者由于限制功能受损导致的大量进食。本文报告了我们对腹腔镜RYGBP术后出现体重反弹患者的治疗经验，这些患者因出现大量进食或食欲亢进，通过在胃囊周围腹腔镜置入不可调节硅胶环进行治疗。
2004年7月至2007年11月，6例因食欲亢进行为导致体重反弹的患者接受了RYGBP修正手术，即置入一个不可调节的硅胶环，松散地环绕胃部。RYGBP手术时的平均体重和体重指数（BMI）分别为105.0 kg±12.3和36.3±3.0 kg/m²，所有患者均患有肥胖相关合并症。RYGBP术后平均26.0±14.2个月，患者体重较最低体重反弹了4.7±3.4 kg，硅胶环置入时的最终平均体重、BMI和超重减轻百分比（%EWL）分别为86.0±13.1 kg、29.5±3.9 kg/m²和47.0±24.7%。每位患者的术前评估包括病史和体格检查、营养和精神评估、实验室检查以及吞钡检查。观察指标包括对Roux-en-Y结构的评估、手术时间、术后发病率和死亡率，以及绝对体重减轻、BMI和%EWL方面的体重减轻情况。
未发现消化回路有任何改变。平均手术时间为82.5±18.3分钟。未发生手术死亡，也未转为开放手术。未出现术后并发症。平均住院时间为2.6±1.5天。平均随访14.0±9.2个月后，6例患者平均体重减轻了9.1±2.4 kg，最终平均体重、BMI和%EWL分别为76.8±13.7 kg、26.4±4.2 kg/m²和70.4±30.4%。修正前后%EWL的差异（23.4±5.7）具有统计学意义（p<0.05）。随访期间未出现环的侵蚀或滑脱。
RYGBP术后体重反弹的一个可能原因是患者新的饮食行为，其中之一是食欲亢进。治疗这种情况可以在胃囊周围松散地置入一个不可调节的硅胶环，这有助于改善体重减轻。
