Spyropoulos Charalambos, Kehagias Ioannis, Panagiotopoulos Spyros, Mead Nancy, Kalfarentzos Fotis
Department of Surgery, School of Medicine, University of Patras, Greece, Platia Voriou Ipirou 5, Patras, Greece.
Arch Surg. 2010 Feb;145(2):173-7. doi: 10.1001/archsurg.2009.260.
To evaluate the safety and effectiveness of revisional bariatric surgery at a tertiary institution. Revisional bariatric operations for unsuccessful weight loss or intolerable complications following the primary intervention are increasing.
Case series from a prospective database.
Tertiary bariatric referral center.
From 1995 to 2008, 56 patients who had been formerly operated on for clinically severe obesity underwent a revisional procedure at our institution. Their mean (SD) age and body mass index were 39.6 (9.6) years and 46.9 (16.4), respectively. They were divided into 3 groups according to the indications for reoperation: (1) unsatisfactory weight loss (n = 39), (2) severe nutritional complications (n = 15), and (3) intolerable adverse effects (n = 2).
Effectiveness of the procedures according to the indication of revision and overall morbidity and mortality rates.
Mean (SD) follow-up was 102 (8) months. There was no mortality but there was an early morbidity rate of 33.9% due to postoperative complications, including 2 cases of acute renal failure (3.6%), 5 anastomotic leaks (13.1%), 8 cases of pneumonia (14.3%), and 1 case each of wound infection, incisional dehiscence, bile leak, and small-bowel obstruction (1.8%). Late complications included stenosis of the gastrojejunal anastomosis in 2 patients (3.6%), hypoalbuminemia in 2 patients (3.6%), and incisional herniation in 9 patients (16.1%). Late morbidity was 23.2%.
Although revisional bariatric surgery is associated with higher risk of perioperative complications compared with the primary procedures, it appears to be safe and effective when performed in experienced centers.
评估在一家三级医疗机构进行的减肥手术翻修术的安全性和有效性。因初次干预后减肥失败或出现无法耐受的并发症而进行的减肥手术翻修术正在增加。
来自前瞻性数据库的病例系列。
三级减肥转诊中心。
1995年至2008年，56例曾因临床严重肥胖接受过手术的患者在我们机构接受了翻修手术。他们的平均（标准差）年龄和体重指数分别为39.6（9.6）岁和46.9（16.4）。根据再次手术的指征，他们被分为3组：（1）减肥效果不理想（n = 39），（2）严重营养并发症（n = 15），以及（3）无法耐受的不良反应（n = 2）。
根据翻修指征评估手术的有效性以及总体发病率和死亡率。
平均（标准差）随访时间为102（8）个月。无死亡病例，但术后并发症导致的早期发病率为33.9%，包括2例急性肾衰竭（3.6%）、5例吻合口漏（13.1%）、8例肺炎（14.3%）以及各1例伤口感染、切口裂开、胆漏和小肠梗阻（1.8%）。晚期并发症包括2例胃空肠吻合口狭窄（3.6%）、2例低蛋白血症（3.6%）和9例切口疝（16.1%）。晚期发病率为23.2%。
尽管与初次手术相比，减肥手术翻修术围手术期并发症风险更高，但在经验丰富的中心进行时似乎是安全有效的。
