Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.
Surg Obes Relat Dis. 2011 Jan-Feb;7(1):38-43. doi: 10.1016/j.soard.2010.08.005. Epub 2010 Aug 19.
Repeat sleeve gastrectomy (re-SG) and the addition of the duodenal switch (DS) are possible options to increase weight loss after isolated SG (ISG). We report the feasibility, safety, and outcomes of laparoscopic re-SG versus DS in patients presenting with insufficient weight loss or weight regain after ISG.
From November 2003 to December 2009, 7 and 19 patients underwent laparoscopic re-SG and DS, respectively, mainly because of the patients' dietary habits: volume eating (hyperphagia) was treated by re-SG and eating meals too frequently (polyphagia) by DS.
At ISG, the mean weight and BMI was 127.7 ± 31.4 kg, and 45.1 ± 11.8 kg/m(2) for the re-SG group and 119.8 ± 20.9 kg and 41.2 ± 5.5 kg/m(2) for the DS group, respectively. The mean interval between ISG and reoperation was 37.1 ± 20.3 months for the re-SG group and 29.8 ± 24.9 months for the DS group. At reoperation, the mean weight, BMI, and percentage of excess weight loss (%EWL) was 109.7 ± 21 kg, 38.9 ± 8.7 kg/m(2), 24.3 ± 16.6% for the re-SG group and 107.6 ± 19.6 kg, 36.9 ± 4.2 kg/m(2), and 19.5 ± 19.9% for the DS group, respectively. The mean operative time was 137.5 ± 75.5 minutes for the re-SG group and 152.6 ± 54.3 minutes for the DS group. No conversion to open surgery was required, and no mortality occurred. One patient in the re-SG group developed a leak at the angle of His. In the DS group, 1 patient presented with bleeding, 1 patient with a duodenoileostomy leak, and 1 patient with a duodenoileostomy stenosis. The mean hospital stay was 11.5 ± 20.5 days for the re-SG group and 4.7 ± 2.7 days for the DS group. The mean follow-up was 23.2 ± 11.1 months for the re-SG group and 24.9 ± 20.1 months for the DS group. The mean weight, BMI, and %EWL was 100 ± 21.1 kg, 35.3 ± 8.3 kg/m(2), 43.7 ± 24.9% for the re-SG group and 80.7 ± 22.5 kg, 27.3 ± 5.2 kg/m(2), 73.7 ± 27.7% for the DS group, respectively. During follow-up, 3 patients in the DS group required corrective surgery for late complications.
The results of the present study have shown that laparoscopic re-SG is feasible but carries the risk of fistula development, which is difficult to treat. Laparoscopic DS was also shown to be feasible at a cost of not negligible complications, which are easier to manage than with re-SG. The efficacy seemed greater after DS than after re-SG.
袖状胃切除术（re-SG）后再次进行十二指肠转位术（DS）是增加孤立性袖状胃切除术（ISG）后减重效果的可能选择。我们报告了在 ISG 后出现减重不足或体重反弹的患者中，腹腔镜下 re-SG 与 DS 的可行性、安全性和结果。
从 2003 年 11 月至 2009 年 12 月，分别有 7 例和 19 例患者接受了腹腔镜下 re-SG 和 DS，主要是因为患者的饮食习惯：容积进食（贪食症）通过 re-SG 治疗，进食次数过于频繁（多食症）通过 DS 治疗。
在 ISG 时，re-SG 组的平均体重和 BMI 为 127.7 ± 31.4kg 和 45.1 ± 11.8kg/m²，DS 组分别为 119.8 ± 20.9kg 和 41.2 ± 5.5kg/m²。re-SG 组和 DS 组的 ISG 与再次手术之间的平均间隔时间分别为 37.1 ± 20.3 个月和 29.8 ± 24.9 个月。在再次手术时，re-SG 组的平均体重、BMI 和超重减轻百分比（%EWL）分别为 109.7 ± 21kg、38.9 ± 8.7kg/m²、24.3 ± 16.6%，DS 组分别为 107.6 ± 19.6kg、36.9 ± 4.2kg/m²和 19.5 ± 19.9%。re-SG 组的平均手术时间为 137.5 ± 75.5 分钟，DS 组为 152.6 ± 54.3 分钟。没有转为开放手术，也没有死亡病例。re-SG 组 1 例患者出现吻合口漏，DS 组 1 例患者出现出血，1 例患者出现胆肠漏，1 例患者出现胆肠狭窄。re-SG 组的平均住院时间为 11.5 ± 20.5 天，DS 组为 4.7 ± 2.7 天。re-SG 组和 DS 组的平均随访时间分别为 23.2 ± 11.1 个月和 24.9 ± 20.1 个月。re-SG 组的平均体重、BMI 和 %EWL 分别为 100 ± 21.1kg、35.3 ± 8.3kg/m²、43.7 ± 24.9%，DS 组分别为 80.7 ± 22.5kg、27.3 ± 5.2kg/m²、73.7 ± 27.7%。在随访期间，DS 组有 3 例患者因晚期并发症需要进行矫正手术。
本研究结果表明，腹腔镜下 re-SG 是可行的，但存在瘘管发展的风险，且难以治疗。腹腔镜 DS 也可行，但代价是不可忽视的并发症，其处理比 re-SG 更容易。DS 后的疗效似乎比 re-SG 后更好。
