Bariatric and Metabolic Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
Obes Surg. 2013 Nov;23(11):1766-73. doi: 10.1007/s11695-013-1012-1.
There are growing numbers of patients who require revisional bariatric surgery due to the undesirable results of their primary procedures. The aim of this study was to review our experience with bariatric patients undergoing revisional surgery.
We conducted a retrospective analysis to review the indications for revisional bariatric procedures and assess their postoperative outcomes.
From 04/04 to 01/11, 2,918 patients underwent bariatric surgery at our institution. A total of 154 patients (5.3%) of these cases were coded as revisional procedures. The mean age at revision was 49.1 ± 11.3 and the mean BMI was 44.0 ± 13.7 kg/m2. Revisional surgery was performed laparoscopically in 121 patients (78.6%). Laparoscopic revisions had less blood loss, shorter length of hospital stay, and fewer complications compared to open revisions. Two groups (A and B) were defined by the indication for revision: patients with unsuccessful weight loss (group A, n = 106) and patients with complications of their primary procedures (group B, n = 48). In group A, 74.5% of the patients were revised to a bypass procedure and 25.5% to a restrictive procedure. Mean excess weight loss was 53.7 ± 29.3% after revision of primary restrictive procedures and 37.6 ± 35.1% after revision of bypass procedures at >1-year follow-up (p < 0.05). In group B, the complications prompting revision were effectively treated by revisional surgery.
Revisional bariatric surgery effectively treated the undesirable results from primary bariatric surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic bariatric procedures without a prohibitive complication rate. Carefully selected patients undergoing revision for weight regain have satisfactory additional weight loss.
由于初次手术效果不理想，越来越多的患者需要进行减重手术翻修。本研究旨在回顾我们在减重手术翻修患者中的经验。
我们进行了一项回顾性分析，以回顾减重手术翻修的适应证，并评估其术后结果。
自 2004 年 4 月至 2021 年 1 月，我院共进行了 2918 例减重手术。其中，154 例（5.3%）被编码为翻修手术。翻修时的平均年龄为 49.1±11.3 岁，平均 BMI 为 44.0±13.7kg/m2。121 例（78.6%）患者行腹腔镜翻修术。与开腹翻修术相比，腹腔镜翻修术出血量较少，住院时间较短，并发症较少。根据翻修原因将患者分为两组（A 组和 B 组）：一组为减重效果不佳的患者（A 组，n=106），另一组为初次手术并发症的患者（B 组，n=48）。在 A 组中，74.5%的患者接受旁路手术，25.5%的患者接受限制手术。初次限制手术翻修后 1 年时，平均超重体重减轻 53.7±29.3%，初次旁路手术翻修后 1 年时，平均超重体重减轻 37.6±35.1%（p<0.05）。在 B 组中，促使翻修的并发症通过翻修手术得到有效治疗。
减重手术翻修有效地治疗了初次减重手术的不良后果。腹腔镜翻修术可在初次开腹或腹腔镜手术后进行，且并发症发生率并不高。对因体重反弹而行翻修的患者进行精心选择后，可获得满意的额外减重效果。
