单中心再次减重手术。

Revisional bariatric surgery at a single institution.

机构信息

Department of Surgery, Northwestern University, Chicago, IL 60611, USA.

出版信息

Am J Surg. 2010 Nov;200(5):651-4. doi: 10.1016/j.amjsurg.2010.07.012.

DOI:10.1016/j.amjsurg.2010.07.012

PMID:21056147

Abstract

BACKGROUND

Bariatric surgery, although safe, can have long-term complications that require revision. Our series illustrates the spectrum of primary procedures, indications for surgery, and strategies for revision.

METHODS

The study was a retrospective chart review. Sixty-three patients were identified. Of specific interest were complications and percentage of excess weight loss (EWL) during the follow-up period.

RESULTS

Eighteen patients had a previous vertical banded gastroplasty (VBG), 26 had a Roux-en-Y gastric bypass (RYGB), 18 had a laparoscopic adjustable gastric banding (LAGB), and 1 had a jejunal-ileal bypass. All VBG patients were revised to RYGB. Seventeen RYGB patients were revised with RYGB. Eight LAGB patients were revised with RYGB. Eight RYGB patients had placement of LAGB. Two LAGB patients were revised with LAGB because of a slipped band. Eight LAGB patients had the band removed. The morbidity rate was 30% with a major morbidity rate of 11%. There were 2 leaks, neither required reoperation. Other major complications included 3 pneumonias, 2 reoperations, and 2 intra-abdominal abscesses. There were no mortalities. In the 15 patients who had conversion of VBG to RYGB, the mean EWL was 50%, with 60% of patients achieving more than 50% EWL. In the 10 patients who had revision of their RYGB, the mean EWL was 51%, with 60% of patients achieving more than 50%. In the 6 patients who had revision of LAGB to RYGB, the mean EWL was 39%, with 33% of patients achieving more than 50% EWL. In the 8 patients who had LAGB after RYGB the mean EWL was -2%, with 0% of patients achieving more than 50%.

CONCLUSIONS

Revisional surgery is effective, although complication rates are higher than primary bariatric surgery. The type of initial and revisional procedure affects EWL.

摘要

背景

减重手术虽然安全，但可能会产生长期并发症，需要进行修正。我们的系列研究说明了主要手术程序、手术适应证和修正策略的范围。

方法

该研究为回顾性图表回顾。确定了 63 名患者。特别关注的是随访期间的并发症和超重减轻百分比（EWL）。

结果

18 名患者进行了垂直束带胃成形术（VBG），26 名患者进行了 Roux-en-Y 胃旁路术（RYGB），18 名患者进行了腹腔镜可调胃束带术（LAGB），1 名患者进行了空肠-回肠旁路术。所有 VBG 患者均修正为 RYGB。17 名 RYGB 患者经 RYGB 修正。8 名 LAGB 患者经 RYGB 修正。8 名 RYGB 患者置入 LAGB。2 名 LAGB 患者因带滑脱而修正为 LAGB。8 名 LAGB 患者去除了带子。发病率为 30%，主要发病率为 11%。有 2 例漏诊，均无需再次手术。其他主要并发症包括 3 例肺炎、2 例再次手术和 2 例腹腔脓肿。无死亡病例。在 15 例将 VBG 转换为 RYGB 的患者中，平均 EWL 为 50%，60%的患者实现了超过 50%的 EWL。在 10 例修正 RYGB 的患者中，平均 EWL 为 51%，60%的患者实现了超过 50%的 EWL。在 6 例将 LAGB 修正为 RYGB 的患者中，平均 EWL 为 39%，33%的患者实现了超过 50%的 EWL。在 8 例 RYGB 后行 LAGB 的患者中，平均 EWL 为-2%，无患者实现超过 50%的 EWL。