Center for Weight Loss Surgery, Federal Way, WA, USA.
Obes Surg. 2011 Jul;21(7):825-31. doi: 10.1007/s11695-010-0280-2.
Twenty percent of gastric restrictive operations require revision. Conversion to Proximal Roux-en-Y gastric bypass (PRNYGBP) is associated with weight regain. Forty-one percent of these fail to achieve a body mass index (BMI) < 35. Few report follow-up (F/U) or quality of life (QOL) beyond 5 years. We report the long-term effectiveness of MRNYGBP as a revision.
Retrospective chart review of patients (1993-2005) with a failed gastric restrictive operation (S1) at least a year out from revision (S2) to a MRNYGBP: small lesser curve 22 ± 10 (11-55) cm(3) pouch, long biliopancreatic limb, 150 cm alimentary limb, 141 ± 24 (102-190) cm common channel. Staple-line disruptions were excluded.
Thirty-eight (37 F, 1 M) patients aged 46 ± 8 (17-56) years underwent conversion to a MRYGBP 8 ± 5 (2-23) years after: gastroplasty 25, adjustable gastric band 13 for weight regain (79%), gastroesophageal reflux disease (GERD; 29%), and band problems (24%). S1 provided only 24 ± 25% excess weight loss (EWL; 5.9 ± 6.3 BMI drop) and caused GERD in 32% of patients (p = 0.0124). There were no deaths or leaks. BMI dropped from 41.4 ± 7.8 to 27.3 ± 5.6 (down 20.5 ± 8.3 from S1), 80.1 ± 23.3% EWL (n = 32) at year 1 (p < 0.0001). This was maintained for 10 years. BMI was 28 ± 4 (21.5-31.9), 75.6 ± 21.1% EWL (57.3-109.6) (n = 5) at 10 years. Super obese patients had better 9.95% EWL after S2 (p = 0.0359). QOL (5 = excellent): 4.5 ± 0.5 (3-5). F/U: 5.1 ± 3.3 (1-13) years with 83.3% F/U 10-year rate. Labs at 3 years (n = 10): Alb 3.8 ± 0.4, Prot 6.8 ± 0.6, Iron 47.6 ± 33.3, VitD 15.1 ± 7.43, PTH 54.5 ± 27.2, B12 620.1 ± 676.5, Hct 34 ± 4.3.
Revision MRNYGBP provides excellent durable long-term weight loss after failed gastric restrictive operations. Non-compliant patients are at a higher risk for malnutrition, anemia, and osteoporosis.
20%的胃限制手术需要进行修正。转换为近端 Roux-en-Y 胃旁路术（PRNYGBP）与体重反弹有关。其中 41%的患者未能达到体重指数（BMI）<35。很少有报告对术后 5 年以上的情况进行随访（F/U）或生活质量（QOL）评估。我们报告了 MRNYGBP 作为一种修正方法的长期有效性。
对至少在修正（S2）后 1 年接受失败胃限制手术（S1）的患者（1993-2005 年）进行回顾性图表审查：小的胃小弯 22 ± 10（11-55）cm³ 袋，长的胆胰支，150cm 食物支，141 ± 24（102-190）cm 共同通道。排除吻合口破裂。
38 名（37 名女性，1 名男性）患者年龄 46 ± 8（17-56）岁，在 S1 后 8 ± 5（2-23）年接受了 MRYGBP 转换：胃成形术 25 例，可调胃带 13 例用于体重反弹（79%），胃食管反流病（GERD；29%）和带问题（24%）。S1 仅提供了 24 ± 25%的额外体重减轻（EWL；5.9 ± 6.3 BMI 下降），并导致 32%的患者出现 GERD（p = 0.0124）。无死亡或渗漏。BMI 从 41.4 ± 7.8 下降到 27.3 ± 5.6（与 S1 相比下降 20.5 ± 8.3），第 1 年的 EWL 为 80.1 ± 23.3%（n = 32）（p < 0.0001）。这在 10 年内得到了维持。BMI 为 28 ± 4（21.5-31.9），EWL 为 75.6 ± 21.1%（n = 5），在 10 年时为 57.3-109.6。超级肥胖患者在 S2 后有更好的 9.95%EWL（p = 0.0359）。QOL（5=优秀）：4.5 ± 0.5（3-5）。F/U：5.1 ± 3.3（1-13）年，83.3%的患者在 10 年内进行了 F/U。3 年时的实验室检查（n = 10）：Alb 3.8 ± 0.4，Prot 6.8 ± 0.6，铁 47.6 ± 33.3，VitD 15.1 ± 7.43，PTH 54.5 ± 27.2，B12 620.1 ± 676.5，Hct 34 ± 4.3。
修正后的 MRNYGBP 为失败的胃限制手术后提供了极好的持久长期减重效果。不遵守治疗方案的患者存在更高的营养不良、贫血和骨质疏松风险。
