Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.
Surg Endosc. 2010 Jun;24(6):1490-3. doi: 10.1007/s00464-009-0796-5. Epub 2010 Jan 1.
This report describes the laparoscopic conversion of a Roux-en-Y gastric bypass (RYGBP) to biliopancreatic diversion (BPD).
In January 1995, a 47-year-old woman with a body mass index (BMI) of 54 kg/m(2) benefited from a silicon ring vertical banded gastroplasty (SRVBG) for morbid obesity. She showed significant weight loss and reached a BMI of 30 kg/m(2). After 7 years, she experienced weight regain (BMI, 34.5 kg/m(2)), so a laparoscopic conversion to RYGBP was proposed. The patient again had a successful weight loss (BMI, 26 kg/m(2)), but 6 years later, she mentioned a weight regain (BMI, 33 kg/m(2)) with invalidating retrosternal pain. The nutritionist's analysis of the patient showed a certain modification of the alimentary character with frequent meals (grazing/polyphagia), and the psychologist's consultation identified an important binge-eating disorder. A laparoscopic conversion of RYGBP to BPD was proposed. The procedure consisted of (1) adhesiolysis and reduction of a hiatal hernia, (2) sectioning of the gastric pouch proximally to the gastrojejunostomy, (3) resection of the fundus of the gastric remnant excluded by the previous SRVBG, (4) restoration of the continuity of the stomach between the gastric pouch and the gastric remnant, (5) resection of the gastric antrum and pylorus, (6) deconstruction of the previous jejunojejunostomy, (7) restoration of the continuity of the small bowel, (8) measurement of the new common and alimentary limbs and construction of the jejunoileostomy, (9) closure of the mesenteric defect, (10) construction of the gastroileostomy, (11) closure of Petersen's space, and (12) repair of the hiatal hernia followed by a leak test.
The operative time was 320 min, and the blood loss was 380 ml. The patient had an uneventful recovery and was discharged on postoperative day 5. Her BMI was 30.5 kg/m(2) after 3 months and 26 kg/m(2) after 6 months. The barium swallow showed good transit through the gastrointestinal tract.
The laparoscopic conversion of RYGBP to BPD is technically feasible and effective during the short term for cases of repeated weight regain.
本报告描述了一例腹腔镜下 Roux-en-Y 胃旁路术（RYGBP）转为胆胰分流术（BPD）的病例。
1995 年 1 月，一位 47 岁女性，BMI 为 54kg/m²，因病态肥胖接受了硅环垂直带胃成形术（SRVBG）。她的体重显著减轻，BMI 达到 30kg/m²。7 年后，她出现体重反弹（BMI 为 34.5kg/m²），因此提出了腹腔镜 RYGBP 转为 RYGBP 的建议。患者再次成功减重（BMI 为 26kg/m²），但 6 年后，她诉胸骨后疼痛复发且体重反弹（BMI 为 33kg/m²）。营养师对患者的分析显示，其饮食习惯有一定改变，进食频繁（暴食/多食），而心理学家的咨询则确定了其存在严重的暴食障碍。因此，提出将 RYGBP 转为 BPD。手术过程包括：（1）松解粘连，修复食管裂孔疝；（2）于胃空肠吻合口近端离断胃小囊；（3）切除以前 SRVBG 切除的胃残端的胃底；（4）重建胃小囊和胃残端之间的胃连续性；（5）切除胃窦和幽门；（6）拆除先前的空肠空肠吻合术；（7）重建小肠连续性；（8）测量新的共同和喂养支，并构建空肠回肠吻合术；（9）关闭肠系膜缺损；（10）构建胃空肠吻合术；（11）关闭 Petersen 间隙；（12）修复食管裂孔疝，然后进行漏诊测试。
手术时间 320 分钟，失血量 380ml。患者术后恢复顺利，术后第 5 天出院。术后 3 个月和 6 个月时，患者 BMI 分别为 30.5kg/m²和 26kg/m²。钡餐检查显示胃肠道通过良好。
对于反复体重反弹的病例，腹腔镜下 RYGBP 转为 BPD 在短期内是可行且有效的。
