Division of GI and MIS surgery, Department of Surgery, Carolinas Simulation Center, Carolinas Weight Management, Carolinas Healthcare System, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, USA,
Surg Endosc. 2013 Dec;27(12):4504-10. doi: 10.1007/s00464-013-3097-y. Epub 2013 Aug 14.
Revisional bariatric procedures are on the rise. The higher complexity of these procedures has been reported to lead to increased risk of complications. The objective of our study was to compare the perioperative risk profile of revisional bariatric surgery with primary bariatric surgery in our experience.
A prospectively maintained database of all patients undergoing bariatric surgery by three fellowship-trained bariatric surgeons from June 2005 to January 2013 at a center of excellence was reviewed. Patient demographics, type of initial and revisional operation, number of prior gastric surgeries, indications for revision, postoperative morbidity and mortality, length of stay, 30-day readmissions, and reoperations were recorded. These outcomes were compared between revisional and primary procedures by the Mann-Whitney or Chi square tests.
Of 1,556 patients undergoing bariatric surgery, 102 patients (6.5%) underwent revisional procedures during the study period. Indications for revisions included inadequate weight loss in 67, failed fundoplications with recurrent gastroesophageal reflux disease in 29, and other in 6 cases. Revisional bariatric procedures belonged into four categories: band to sleeve gastrectomy (n = 23), band to Roux-en-Y gastric bypass (n = 25), fundoplication to bypass (n = 29), and other (n = 25). Revisional procedures were associated with higher rates of readmissions and overall morbidity but no differences in leak rates and mortality compared with primary procedures. Band revisions had similar length of stay with primary procedures and had fewer complications compared with other revisions. Patients undergoing fundoplication to bypass revisions were older, had a higher number of prior gastric procedures, and the highest morbidity (40%) and reoperation (20%) rates.
In experienced hands, many revisional bariatric procedures can be accomplished safely, with excellent perioperative outcomes that are similar to primary procedures. As the complexity of the revisional procedure and number of prior surgeries increases, however, so does the perioperative morbidity, with fundoplication revisions to gastric bypass representing the highest risk group.
减重手术的翻修率正在上升。据报道，这些手术的复杂性更高，导致并发症的风险增加。我们的研究目的是比较我们经验中减重手术翻修与初次手术的围手术期风险特征。
回顾了 2005 年 6 月至 2013 年 1 月期间，由三位接受过减重手术培训的外科医生在卓越中心进行的所有减重手术患者的前瞻性维护数据库。记录患者的人口统计学数据、初次和翻修手术的类型、既往胃手术的数量、翻修的指征、术后发病率和死亡率、住院时间、30 天再入院率和再次手术。通过 Mann-Whitney 或卡方检验比较翻修和初次手术的结果。
在 1556 名接受减重手术的患者中，102 名（6.5%）在研究期间接受了翻修手术。翻修的指征包括 67 例减重效果不满意、29 例胃食管反流病复发的胃底折叠术失败和 6 例其他原因。减重手术翻修可分为以下四类：带袖状胃切除术（n=23）、带 Roux-en-Y 胃旁路术（n=25）、胃底折叠术至旁路术（n=29）和其他（n=25）。翻修手术与较高的再入院率和总发病率相关，但与初次手术相比，漏诊率和死亡率没有差异。带的翻修与初次手术的住院时间相似，且并发症较少，而其他翻修则与之相反。接受胃底折叠术至旁路术翻修的患者年龄较大，既往胃手术数量较多，发病率（40%）和再次手术（20%）的风险最高。
在经验丰富的医生手中，许多减重手术翻修可以安全完成，且围手术期结果与初次手术相似。然而，随着翻修手术的复杂性和既往手术次数的增加，围手术期发病率也会增加，胃底折叠术至旁路术的翻修代表了风险最高的群体。
