Department of Surgery, University Medical Center at Princeton, Princeton, New Jersey 08540, USA.
Surg Obes Relat Dis. 2009 Nov-Dec;5(6):673-6. doi: 10.1016/j.soard.2009.08.002. Epub 2009 Aug 19.
No guidelines are available to assist surgeons in determining whether reversal is appropriate for patients with problematic bariatric operations.
A retrospective review of 2573 primary and 252 revisional bariatric operations was performed to determine the indications for the reversal of problematic bariatric operations.
Of the 82 patients who had undergone reoperation for complications of the primary operation, 13 had undergone reversal rather than revision. Reversal was performed at the patient's request for 5 patients with intractable vomiting after banded restrictive operations and 2 patients with intractable diarrhea after jejunoileal bypass. The surgeon recommended reversal for the remaining 6 patients, including 3 with active substance abuse and 3 with severe metabolic complications. One postoperative complication (wound infection) occurred, with no deaths.
The decision to reverse, rather than revise, a problematic bariatric operation is motivated by the perspective that the outcome of revision would also be problematic. Improved patient education and follow-up by the primary surgeon might have obviated the need for reversal in about one half of the patients in the present series.
目前尚无指南可帮助外科医生确定对于存在问题的减重手术患者是否适合进行反转。
对 2573 例初次减重手术和 252 例再次减重手术进行回顾性分析，以确定对存在问题的减重手术进行反转的适应证。
在因初次手术并发症而接受再次手术的 82 例患者中，有 13 例进行了反转而不是修正。对 5 例因带囊限制性手术出现顽固呕吐和 2 例因空回肠旁路术出现顽固腹泻的患者，是应患者要求进行反转。对于其余 6 例患者，医生建议进行反转，其中包括 3 例有物质滥用和 3 例有严重代谢并发症。仅发生 1 例术后并发症（伤口感染），无死亡病例。
选择对存在问题的减重手术进行反转而非修正的决定是基于这样一种观点，即修正的结果也可能存在问题。通过对初次手术医生进行患者教育和随访，本系列中约有一半的患者可能无需进行反转。
