Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium.
Surg Obes Relat Dis. 2011 Nov-Dec;7(6):703-8. doi: 10.1016/j.soard.2011.09.007. Epub 2011 Sep 17.
Morbidity and mortality after bariatric surgery in superobese (body mass index [BMI] >50 but <60 kg/m2) and super-superobese (BMI >60 kg/m2) patients can allegedly be reduced by performing surgery in 2 steps. We report a retrospective study gathered from a prospective database for superobese and super-superobese patients who underwent laparoscopic biliopancreatic diversion/duodenal switch (LBPD/DS) after laparoscopic sleeve gastrectomy (LSG) as the first step.
From October 2004 to June 2010, 31 patients underwent LBPD/DS after LSG. The mean age was 45.8 ± 10.1 years (range 21-64). The mean interval between the 2 procedures was 13.9 ± 8.4 months (range 6-37). At LSG, the mean weight and BMI was 168.8 ± 35.4 kg (range 127-255) and 58.3 ± 6.7 kg/m2 (range 50-74.5). At LBPD/DS, the mean weight, BMI, and percentage of excess weight loss was 136.3 ± 32.6 kg (range 92-220), 47.1 ± 7.2 kg/m(2) (range 37.8-64.3), and 31.6% ± 12.2% (range -11.7 to +54.6). At LSG, 26 patients had 43 obesity co-morbidities. Three co-morbidities (6.9%) resolved in 3 patients before the second step of LBPD/DS was performed.
The mean operative time was 175.5 ± 60.6 minutes (range 75-285). There were no deaths or conversions to open surgery. Four patients had early complications (1 anastomotic leak, 1 small bowel perforation, 1 case of renal insufficiency, and 1 case of pneumonia). The mean hospital stay was 6.6 ± 8 days (range 3-35). All patients, with the exception of 3, were followed up for a mean of 28.8 ± 21.4 months (range 4-71). At follow-up, the mean weight, BMI, and percentage of excess weight loss (compared with the pre-LSG weight) was 99.4 ± 23.7 kg (range 62-150), 34.5 ± 5.8 kg/m2 (range 24.9-46.3), and 54.8% ± 16% (range 18.9-84.8). A total of 22 obesity co-morbidities (51.1%) resolved in 14 patients. Three patients presented with late complications (1 ventral hernia, 1 case of protein deficiency, 1 anastomotic stenosis).
In the treatment of superobese and super-superobese patients with 2-step LBPD/DS, we experienced no deaths and achieved acceptable morbidity, considering the high operative risk in this group. This procedure is effective for both weight loss and resolution of co-morbidities.
超重（体重指数 [BMI] >50 但 <60 kg/m2）和超超级肥胖（BMI >60 kg/m2）患者接受减重手术后的发病率和死亡率据称可以通过分两步手术来降低。我们报告了一项回顾性研究，该研究来自一个前瞻性数据库，纳入了在腹腔镜袖状胃切除术（LSG）后接受腹腔镜胆胰分流/十二指肠转位术（LBPD/DS）的超肥胖和超超级肥胖患者。
从 2004 年 10 月至 2010 年 6 月，31 例患者在 LSG 后接受了 LBPD/DS。平均年龄为 45.8 ± 10.1 岁（范围 21-64 岁）。两次手术之间的平均间隔时间为 13.9 ± 8.4 个月（范围 6-37 个月）。在 LSG 时，平均体重和 BMI 为 168.8 ± 35.4kg（范围 127-255kg）和 58.3 ± 6.7kg/m2（范围 50-74.5kg/m2）。在 LBPD/DS 时，平均体重、BMI 和多余体重减轻百分比分别为 136.3 ± 32.6kg（范围 92-220kg）、47.1 ± 7.2kg/m2（范围 37.8-64.3kg/m2）和 31.6% ± 12.2%（范围 -11.7%至 +54.6%）。在 LSG 时，26 例患者有 43 种肥胖合并症。在进行第二步 LBPD/DS 之前，有 3 例患者（6.9%）的 3 种合并症得到解决。
手术时间平均为 175.5 ± 60.6 分钟（范围 75-285 分钟）。无死亡或转为开放手术。4 例患者出现早期并发症（1 例吻合口漏，1 例小肠穿孔，1 例肾功能不全，1 例肺炎）。平均住院时间为 6.6 ± 8 天（范围 3-35 天）。除 3 例患者外，所有患者均获得随访，平均随访时间为 28.8 ± 21.4 个月（范围 4-71 个月）。随访时，平均体重、BMI 和多余体重减轻百分比（与 LSG 前体重相比）分别为 99.4 ± 23.7kg（范围 62-150kg）、34.5 ± 5.8kg/m2（范围 24.9-46.3kg/m2）和 54.8% ± 16%（范围 18.9-84.8%）。14 例患者（51.1%）的 22 种肥胖合并症得到解决。3 例患者出现晚期并发症（1 例腹疝、1 例蛋白缺乏、1 例吻合口狭窄）。
在对 2 步 LBPD/DS 治疗的超肥胖和超超级肥胖患者中，我们没有死亡，并且考虑到该组患者的高手术风险，发病率可以接受。这种手术对于减轻体重和解决合并症都非常有效。
