Bolton Johan, Gill Richdeep S, Al-Jahdali Akram, Byrns Simon, Shi Xinzhe, Birch Daniel W, Karmali Shahzeer
Department of Surgery, University of Alberta, Edmonton, AB, Canada T6G 2B7.
J Obes. 2013;2013:108507. doi: 10.1155/2013/108507. Epub 2013 Jan 22.
Weight regain secondary to VBG pouch dilation is a typical referral for Bariatric surgeons. In this study we compare an endoluminal pouch reduction (Stomaphyx) to RYGB for revision.
A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003-2010.
Thirty patients were identified for study 23 RYGB, 14 StomaphyX. Significant post procedure BMI loss was seen in each cohort (RYGB, 47.7 ± 7 kg/m(2) to 35 ± 7 kg/m(2); StomaphyX 43 ± 10 kg/m(2) to 40 ± 9 kg/m(2), P = 0.0007). Whereas nausea and headache were the only complications observed in StomaphyX patients, the RYGB group had a 43.5% complication rate and 1 mortality. Complications following RYGB include: incisional hernia (13%), anastomotic leak (8.7%), respiratory failure (8.7%), fistula (8.7%), and perforation (4.35%). The median length of stay following RYGB was 6 days compared to 1.5 ± 0.5 days following StomaphyX.
This study suggests that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Further technical modifications of the device and longer follow-up may clarify the role of this approach.
胃旁路术（VBG）后因胃囊扩张导致的体重反弹是肥胖症外科医生常见的转诊原因。在本研究中，我们比较了腔内胃囊缩小术（Stomaphyx）与Roux-en-Y胃旁路术（RYGB）用于翻修手术的效果。
对2003年至2010年间因体重反弹而接受过VBG手术的患者进行了回顾性研究。
确定了30例患者进行研究，其中23例行RYGB手术，14例行StomaphyX手术。每个队列术后体重指数（BMI）均有显著下降（RYGB组，从47.7±7kg/m²降至35±7kg/m²；StomaphyX组，从43±10kg/m²降至40±9kg/m²，P = 0.0007）。StomaphyX组患者仅观察到恶心和头痛这两种并发症，而RYGB组的并发症发生率为43.5%，有1例死亡。RYGB术后的并发症包括：切口疝（13%）、吻合口漏（8.7%）、呼吸衰竭（8.7%）、瘘（8.7%）和穿孔（4.35%）。RYGB术后的中位住院时间为6天，而StomaphyX术后为1.5±0.5天。
本研究表明，虽然RYGB翻修术可能实现更大程度的体重减轻，但其并发症发生率和严重程度令人沮丧。StomaphyX可能是一种安全的替代方法。对该设备进行进一步的技术改进并延长随访时间可能会明确这种方法的作用。
