Howard University Hospital, Washington, DC, USA.
Obes Surg. 2014 Aug;24(8):1386-90. doi: 10.1007/s11695-014-1216-z.
Reoperative surgery for the morbidly obese has become increasingly common due to postoperative weight regain. There are limited studies evaluating the effectiveness of revisional surgery. This study evaluates the weight loss outcomes of revisional surgery over a 2-year period at our University Hospital, USA. Of the 412 patients who underwent laparoscopic bariatric surgery between June 2009 and June 2011, we identified 25 patients who had Roux-en-Y gastric bypass (RYGB) originally, who underwent laparoscopic revisional surgery for weight regain. Preoperative and postoperative data were reviewed. Statistical analysis was performed using paired t test. This study includes 0 male and 25 female patients with an average age of 42 (range min to max: 28-58), mean original body mass index (BMI) of 54.6 kg/m(2) (r = 37.3-80.7), average lowest BMI achieved of 32.2 (r = 20.1-50.9), and average BMI at the time of revision of 41.0 kg/m(2) (r = 29.5-60.7, standard deviation (SD) = 8.5). All laparoscopic revisions consisted of resizing the gastric pouch by resection and recreating the gastrojejunostomy. Average hospital length of stay was 1.28 days (r = 1-4). Perioperative morbidity was 8 %; one patient developed a trocar site hernia which required repair, and another suffered postoperative bleeding requiring transfusion. There was no mortality. Postoperative BMI averages at 3, 6, 9, 12, and 24 months were 35.0 (SD = 7.15), 34.7 (SD = 4.26), 36.2 (SD = 7.63), 33.0 (SD = 6.58), and 44.2 (SD = 12.87), respectively. Statistically significant weight loss was achieved at 3 [t (10) = 6.74, p < 0.05], 6 [t (7) = 4.69, p < 0.05], 9 [t (9) = 2.94, p < 0.05], and 12 [t (6) = 3.78, p < 0.05] months. However, there was no statistically significant weight loss at 24 months postoperatively [t (4) = -0.16, p > 0.05]. Laparoscopic revisional bariatric surgery can be performed with significant weight loss up to 1 year postoperatively. However, additional studies are required to evaluate longer-term success.
由于术后体重反弹，病态肥胖患者的再次手术变得越来越常见。目前评估修正手术效果的研究有限。本研究评估了我院（美国） 2 年内腹腔镜减重手术的减肥效果。在 2009 年 6 月至 2011 年 6 月间接受腹腔镜减重手术的 412 名患者中，我们发现有 25 名最初接受 Roux-en-Y 胃旁路术（RYGB）的患者因体重反弹而行腹腔镜修正手术。回顾了术前和术后数据。使用配对 t 检验进行了统计分析。本研究包括 0 名男性和 25 名女性患者，平均年龄为 42 岁（最小至最大年龄：28-58 岁），平均原始体重指数（BMI）为 54.6kg/m2（r=37.3-80.7），平均最低 BMI 为 32.2kg/m2（r=20.1-50.9），平均 BMI 在修正时为 41.0kg/m2（r=29.5-60.7，标准差（SD）=8.5）。所有腹腔镜修正术均包括切除和重新形成胃空肠吻合术来缩小胃袋大小。平均住院时间为 1.28 天（r=1-4）。围手术期发病率为 8%；1 名患者发生切口疝，需要修复，另 1 名患者术后出血需要输血。无死亡病例。术后 3、6、9、12 和 24 个月时的 BMI 平均值分别为 35.0（SD=7.15）、34.7（SD=4.26）、36.2（SD=7.63）、33.0（SD=6.58）和 44.2（SD=12.87）。术后 3 个月时体重显著减轻[t（10）=6.74，p<0.05]、6 个月时[t（7）=4.69，p<0.05]、9 个月时[t（9）=2.94，p<0.05]和 12 个月时[t（6）=3.78，p<0.05]。然而，术后 24 个月时体重无显著减轻[t（4）=-0.16，p>0.05]。腹腔镜减重手术修正术可在术后 1 年内显著减轻体重。然而，需要进一步研究来评估长期效果。
