Discipline of Surgery, University of Adelaide, Royal Adelaide Hospital, Adelaide, SA, Australia.
Obes Surg. 2010 Dec;20(12):1627-32. doi: 10.1007/s11695-010-0214-z.
With the increase in bariatric procedures performed, revisional surgery is now required more frequently. Roux-en-Y gastric bypass (RYGB) is considered to be the gold standard revision procedure. However, data comparing revisional vs. primary RYGB is scarce, and no study has compared non-resectional primary and revisional RYGB in a matched control setting. Analysis of 61 revisional RYGB that were matched one to one with 61 primary RYGB was done. Matching criteria were preoperative body mass index, age, gender, comorbidities and choice of technique (laparoscopic vs. open). After matching, the groups did not differ significantly. Previous bariatric procedures were 13 gastric bands, 36 vertical banded gastroplasties, 10 RYGB and two sleeve gastrectomies. The indication for revisional surgery was insufficient weight loss in 55 and reflux in 6. Intraoperative and surgical morbidity was not different, but medical morbidity was significantly higher in revisional procedures (9.8% vs. 0%, p = 0.031). Patients undergoing revisional RYGB lost less weight in the first two postoperative years compared with patients with primary RYGB (1 month, 14.9% vs. 29.7%, p = 0.004; 3 months, 27.4% vs. 51.9%, p = 0.002; 6 months, 39.4 vs. 70.4%, p < 0.001; 12 months, 58.5% vs. 85.9%, p < 0.001; 24 months, 60.7% vs. 90.0%, p = 0.003). Although revisional RYGB is safe and effective, excess weight loss after revisional RYGB is significantly less than following primary RYGB surgery. Weight loss plateaus after 12 months follow-up.
随着减重手术数量的增加，现在需要更频繁地进行修正手术。 Roux-en-Y 胃旁路术（RYGB）被认为是黄金标准修正手术。然而，比较修正与原发性 RYGB 的数据很少，并且没有研究在匹配的对照环境中比较非切除性原发性和修正性 RYGB。对 61 例修正性 RYGB 进行了分析，这些患者与 61 例原发性 RYGB 进行了一对一的匹配。匹配标准为术前体重指数、年龄、性别、合并症和技术选择（腹腔镜与开放）。匹配后，两组无显著差异。先前的减肥手术包括 13 例胃带、36 例垂直带胃成形术、10 例 RYGB 和 2 例袖状胃切除术。修正手术的指征是 55 例减肥效果不佳和 6 例反流。术中及手术发病率无差异，但修正手术的医疗发病率明显更高（9.8%比 0%，p=0.031）。与原发性 RYGB 患者相比，接受修正性 RYGB 的患者在前两年的术后体重减轻量较少（1 个月时，14.9%比 29.7%，p=0.004；3 个月时，27.4%比 51.9%，p=0.002；6 个月时，39.4%比 70.4%，p<0.001；12 个月时，58.5%比 85.9%，p<0.001；24 个月时，60.7%比 90.0%，p=0.003）。虽然修正性 RYGB 是安全有效的，但修正性 RYGB 后的超重减轻量明显少于原发性 RYGB 手术。体重减轻在 12 个月的随访后达到平台期。
