Department of Surgery, Monmouth Medical Center, Central Jersey Specialty Surgical Associates, Shrewsbury, Long Branch, NJ, 07702, USA.
Surg Endosc. 2010 Sep;24(9):2308-13. doi: 10.1007/s00464-010-0919-z. Epub 2010 Mar 4.
Interventional therapy for weight regain after gastric bypass surgery has been tempered by higher complications associated with revisional surgery. Endolumenal reduction of post-bypass stomal and pouch dilatation offers the promise of a safer approach. Questions still remain regarding safety and efficacy with these procedures. We report intra- and postoperative results to date utilizing an endolumenal suturing platform for this patient subset.
Patients who had regained significant weight 2+ years after Roux-en-Y gastric bypass (RYGB) after losing ≥ 50% of excess body weight (EBW) post RYGB underwent endolumenal stomal and pouch reduction if they endoscopically displayed post-bypass stomal and/or pouch dilatation. The platform was utilized to endolumenally reduce stoma size by creating circumferential folds with a tissue anchoring system. Anchors were also utilized to approximate gastric pouch tissue. Information regarding patient baseline status and data on procedural safety, intraoperative performance, postoperative weight loss, and anchor durability were recorded to date with use of this system.
In 20/21 subjects we were able to successfully place anchors (one patient had occult G-G fistula which impaired visualization). Weight regain post RYGB averaged 59 lbs (N = 20). Stomal diameter was reduced on average by 53%, with pouch reduction averaging 41%. The number of anchors placed on average per case was 5.3. Operating room (OR) time averaged 91 min. There were no significant complications. Three- and 12-month esophagogastroduodenoscopy (EGD) results revealed preservation of most of the intraoperative stoma and pouch reduction, and presence of fibrotic tissue folds with continued presence of anchors at their original locations. Mean percentage excess weight loss (%EWL) at 6 months was 18% to date (N = 18). Mean weight loss at 6 months was 17.3 ± 15 lbs.
Clinical study of this endolumenal tissue approximation system has shown intraoperative safety and efficacy in reducing stoma and pouch dilatation post RYGB. Follow-up anchor durability to date is encouraging. Continuing weight loss is being tracked through ongoing endoscopic and clinical follow-up.
胃旁路手术后体重反弹的介入治疗因与修正手术相关的更高并发症而受到限制。旁路后吻合口和袋扩张的腔内缩小提供了一种更安全方法的希望。这些手术的安全性和有效性仍存在疑问。我们报告了迄今为止利用腔内缝合平台治疗这部分患者的术中及术后结果。
在 Roux-en-Y 胃旁路术（RYGB）后体重反弹超过 2 年且在 RYGB 后失去 ≥50%的超重体重（EBW）的患者，如果内镜显示旁路后吻合口和/或袋扩张，则进行腔内吻合口和袋缩小。该平台通过使用组织锚固系统创建环形褶皱来腔内缩小吻合口大小。锚固器还用于接近胃袋组织。迄今为止，使用该系统记录了患者基线状态以及手术安全性、术中表现、术后减重和锚固器耐久性的数据。
在 20/21 例患者中，我们成功放置了锚固器（一名患者存在隐性 G-G 瘘管，这妨碍了可视化）。RYGB 后体重平均增加 59 磅（N=20）。吻合口直径平均缩小 53%，袋缩小平均缩小 41%。平均每个病例放置的锚固器数量为 5.3 个。手术室（OR）时间平均为 91 分钟。没有发生重大并发症。3 个月和 12 个月的食管胃十二指肠镜（EGD）结果显示，大多数术中吻合口和袋缩小得以保留，并且存在纤维组织褶皱，锚固器仍位于其原始位置。迄今为止，6 个月的平均超重体重减轻率（%EWL）为 18%（N=18）。6 个月时的平均体重减轻量为 17.3 ± 15 磅。
该腔内组织接近系统的临床研究显示，RYGB 后吻合口和袋扩张的术中安全性和有效性。迄今为止，对锚定器耐久性的随访结果令人鼓舞。正在通过持续的内镜和临床随访跟踪持续减重情况。
