Mohos Elemer, Jánó Zoltán, Richter Doris, Schmaldienst Elizabeth, Sándor Gábor, Mohos Petra, Horzov Miroslav, Tornai Gábor, Prager Manfred
Department of General Surgery, Territory Hospital Veszprém, Kórház street 1, Veszprém, 8200, Hungary,
Obes Surg. 2014 Dec;24(12):2048-54. doi: 10.1007/s11695-014-1314-y.
The prevalence of morbid obesity and its co-morbidities is dramatically increasing, as is the extent of weight loss surgery. A large number of patients after various bariatric procedures need revisional intervention for various reasons. We investigated the efficacy and the safety of revisional laparoscopic Roux Y gastric bypass (LRYGB) among our patients, who were revised as a consequence of inadequate weight loss or weight regain after previous bariatric interventions.
A comparative, double-centre, match pair study was performed comparing the data of 44 patients after revisional surgery with 44 patients after primary gastric bypasses, focusing on weight loss, life quality and improvement of co-morbidities. Matching criteria were age, gender, preoperative BMI and follow-up period. Previous procedures consisted of 23 gastric bandings, 13 sleeve resections, 4 LRYGB and 4 vertical banded gastroplasties.
Extra weight loss (EWL) was significantly reduced after revisional gastric bypasses compared to primary intervention (EWL 66 vs. 91 %, p<0.05). Life quality scores were also decreased in the revisional group compared to the control group without statistical significance (SF 36 score 635 vs. 698.5, p=0.22; Moorehead-Aldert II score 1.4 vs. 2.0, p=0.10). The resolution rate of co-morbidities (T2DM, hypertension, gastro-oesophageal reflux (GER), osteoarthrosis, sleep apnoea) was also higher after primary gastric bypasses.
Revisional LRYGB is an effective and safe method for patients with inadequate weight loss after previous bariatric surgery concerning weight reduction, life quality and improvement of co-morbidities. Our results indicate lower efficacy of revisional compared to primary LRYGB reaching statistical significance in regard to weight loss.
病态肥胖及其合并症的患病率正在急剧上升，减肥手术的范围也在扩大。大量接受各种减肥手术的患者因各种原因需要进行翻修干预。我们调查了翻修腹腔镜Roux Y胃旁路术（LRYGB）在我们患者中的疗效和安全性，这些患者因先前减肥干预后体重减轻不足或体重反弹而接受翻修。
进行了一项比较性、双中心、配对研究，比较了44例翻修手术后患者与44例初次胃旁路手术后患者的数据，重点关注体重减轻、生活质量和合并症的改善情况。配对标准为年龄、性别、术前BMI和随访期。先前的手术包括23例胃束带术、13例袖状切除术、4例LRYGB和4例垂直带状胃成形术。
与初次干预相比，翻修胃旁路术后额外体重减轻（EWL）显著降低（EWL分别为66%和91%，p<0.05）。与对照组相比，翻修组的生活质量评分也有所下降，但无统计学意义（SF-36评分分别为635和698.5，p=0.22；Moorehead-Aldert II评分分别为1.4和2.0，p=0.10）。初次胃旁路术后合并症（2型糖尿病、高血压、胃食管反流（GER）、骨关节炎、睡眠呼吸暂停）的缓解率也更高。
对于先前减肥手术后体重减轻不足的患者，翻修LRYGB在减轻体重、改善生活质量和合并症方面是一种有效且安全的方法。我们的结果表明，与初次LRYGB相比，翻修的疗效较低，在体重减轻方面达到统计学意义。
