Department of Surgery, Duke University, Durham, NC, USA.
Surg Endosc. 2013 Feb;27(2):548-52. doi: 10.1007/s00464-012-2477-z. Epub 2012 Jul 18.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the most common approaches used to revise post-bariatric patients with inadequate weight loss or significant weight regain. Previous studies have analyzed the outcomes of open revisional RYGB versus primary RYGB, but no case-control matched analysis comparing revisional LRYGB versus primary LRYGB has been performed.
Our cohort includes 37 consecutive patients who underwent revisional LRYGB because of unsatisfactory weight loss or weight regain matched in a 1:2 ratio with 74 control patients who underwent primary LRYGB. Matching included the following parameters: age, gender, preoperative body mass index and comorbidities (diabetes, obstructive sleep apnea, and hypertension).
The revisional group had longer length of stay compared with the primary group (3.8 vs. 2.4 days, P = 0.02) and a higher conversion to laparotomy rate (10.8 vs. 0 %, P = 0.01). The revisional group had a higher 30-day morbidity compared with the primary group (27 vs. 8.1 %, P = 0.02). There were no deaths in both groups. The two groups had similar 30-day readmission and 30 day reoperation rates. At 3, 6, and 12 months of follow-up, the revisional LRYGB group had significantly lower percent of excess weight loss (EWL) than the primary LRYGB group (3 months, 30 vs. 38.4, P = 0.001; 6 months, 36.3 vs. 52.9, P = 0.001; 12 months, 46.5 vs. 68.2, P = 0.001).
Revisional LRYGB is characterized by lower EWL and higher morbidity than primary LRYGB. However, our data suggest that revisional LRYGB is still capable of providing significant weight loss in these high-risk patients.
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）是一种常用于修正减重手术后体重减轻不足或明显反弹的方法。先前的研究分析了开放修正 RYGB 与原发性 RYGB 的结果，但尚未进行修正 LRYGB 与原发性 LRYGB 的病例对照匹配分析。
我们的队列包括 37 例因不满意的体重减轻或体重反弹而行修正 LRYGB 的连续患者，这些患者按 1:2 的比例与 74 例接受原发性 LRYGB 的对照患者相匹配。匹配包括以下参数：年龄、性别、术前体重指数和合并症（糖尿病、阻塞性睡眠呼吸暂停和高血压）。
与原发性组相比，修正组的住院时间更长（3.8 天对 2.4 天，P = 0.02），且转为剖腹手术的比例更高（10.8%对 0%，P = 0.01）。修正组的 30 天发病率高于原发性组（27%对 8.1%，P = 0.02）。两组均无死亡病例。两组的 30 天再入院和 30 天再手术率相似。在 3、6 和 12 个月的随访中，修正 LRYGB 组的超重减轻百分比（EWL）明显低于原发性 LRYGB 组（3 个月，30 对 38.4，P = 0.001；6 个月，36.3 对 52.9，P = 0.001；12 个月，46.5 对 68.2，P = 0.001）。
修正 LRYGB 的特点是 EWL 较低，发病率较高，高于原发性 LRYGB。然而，我们的数据表明，修正 LRYGB 仍然能够为这些高风险患者提供显著的体重减轻。
