Department of Surgery, Division of General Surgery, Section of Foregut and Bariatric Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Surgery, Division of General Surgery, Section of Foregut and Bariatric Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Surg Obes Relat Dis. 2014 Jan-Feb;10(1):36-43. doi: 10.1016/j.soard.2013.05.012. Epub 2013 Jun 29.
The anatomic and physiologic changes with Roux-en-Y gastric bypass (RYGB) may lead to uncommon but occasionally difficult to treat complications such as hyperinsulinemic hypoglycemia with neuroglycopenia and recalcitrant hypocalcemia associated to hypoparathyroidism. Medical management of these complications is challenging. Laparoscopic reversal of RYGB anatomy with restoration of pyloric function and duodenal continuity is a potential treatment. The objective of this study was to present the indications, surgical technique, and clinical outcomes of laparoscopic reversal of RYGB.
Prospective study of consecutive patients offered laparoscopic reversal of RYGB.
Five patients with remote laparoscopic RYGB underwent laparoscopic reversal of RYGB to normal anatomy (n = 2) or modified sleeve gastrectomy (n = 3). Indications were medically refractory hyperinsulinemic hypoglycemia with neuroglycopenia (n = 3), recalcitrant hypocalcemia with hypoparathyroidism (n = 1), and both conditions simultaneously (n = 1). Before reversal, all patients had a gastrostomy tube placed in the excluded stomach to document improvement of symptoms. Laparoscopic reversal was accomplished successfully in all patients. Three postoperative complications occurred: bleeding that required transfusion, gallstone pancreatitis, and a superficial trocar site infection. Average length of stay was 3 days. At a mean follow-up of 12 months (range 3 to 22), no additional episodes of neuroglycopenia occurred, average number of hypoglycemic episodes per week decreased from 18.5 ± 12.4 to 1.5 ± 1.9 (P = .05), and hypocalcemia became responsive to oral replacement therapy in both patients.
Laparoscopic reversal of RYGB to normal anatomy or modified sleeve gastrectomy is feasible and may be a therapeutic option for selected patients with medically refractory hyperinsulinemic hypoglycemia and/or recalcitrant hypocalcemia associated with hypoparathyroidism.
Roux-en-Y 胃旁路术（RYGB）的解剖和生理变化可能导致罕见但偶尔难以治疗的并发症，如伴有神经低血糖的高胰岛素血症性低血糖和与甲状旁腺功能减退相关的难治性低钙血症。这些并发症的医学治疗具有挑战性。腹腔镜下恢复 RYGB 解剖结构并恢复幽门功能和十二指肠连续性是一种潜在的治疗方法。本研究的目的是介绍腹腔镜下 RYGB 逆转的适应证、手术技术和临床结果。
对接受腹腔镜 RYGB 逆转的连续患者进行前瞻性研究。
5 例接受过远程腹腔镜 RYGB 的患者接受了腹腔镜 RYGB 逆转，恢复正常解剖结构（n = 2）或改良袖状胃切除术（n = 3）。适应证为药物难治性伴有神经低血糖的高胰岛素血症性低血糖（n = 3）、伴有甲状旁腺功能减退的难治性低钙血症（n = 1）和同时存在这两种情况（n = 1）。在逆转前，所有患者都在被排除的胃中放置胃造口管以记录症状改善情况。所有患者均成功完成腹腔镜逆转。术后发生 3 例并发症：出血需要输血、胆石性胰腺炎和浅表套管部位感染。平均住院时间为 3 天。在平均 12 个月（3 至 22 个月）的随访中，没有发生神经低血糖的额外发作，每周低血糖发作的平均次数从 18.5 ± 12.4 减少到 1.5 ± 1.9（P =.05），并且在 2 例患者中，低钙血症对口服替代治疗有反应。
腹腔镜下恢复 RYGB 正常解剖结构或改良袖状胃切除术是可行的，对于药物难治性伴有神经低血糖的高胰岛素血症性低血糖和/或与甲状旁腺功能减退相关的难治性低钙血症的患者，可能是一种治疗选择。
