Cheung Douglas, Switzer Noah J, Gill Richdeep S, Shi Xinzhe, Karmali Shahzeer
Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Obes Surg. 2014 Oct;24(10):1757-63. doi: 10.1007/s11695-014-1332-9.
Revisional bariatric surgery following laparoscopic sleeve gastrectomy (LSG) failure presents a clinical challenge for the bariatric surgeon. Limited evidence exists in selecting the appropriate revisional operation: laparoscopic gastric bypass (LGB), laparoscopic re-sleeve gastrectomy (LRSG), or other surgical intervention (OSI), to address weight regain. We systematically reviewed the literature to assess the efficacy of existing revisional surgery. A comprehensive search of electronic databases (e.g., Medline, Embase, Scopus, Web of Science, and the Cochrane Library) was completed. All randomized controlled trials, non-randomized comparison study, and case series were included. Eleven primary studies (218 patients) were identified and included in the systematic review. Studies were grouped into three main categories: LGB, LRSG, and OSI. Preoperative body mass index (BMI) was 41.9 kg/m(2) (LGB), 38.5 kg/m(2) (LRSG), and 44.4 kg/m(2) (OSI). After conversion to LGB, BMI decreased to 33.7 and 35.7 kg/m(2) at 12 and 24 months of follow-up, respectively. Excess weight loss (EWL) was 60 and 48 % over the same periods. After LRSG, BMI decreased to 30.4 and 35.3 kg/m(2) with corresponding EWL of 68 and 44 %, at 12 and 24 months, respectively. After OSI, BMI decreased to 27.3 kg/m(2) with an EWL of 75 % at 24-month follow-up but could not be analyzed due to incomplete data collection in primary studies. Both LGB and LRSG achieve effective weight loss following failed LSG. The less technically challenging nature of LRSG may be more widely applicable. Further research is required to elicit sustainability in long-term weight loss benefits.
腹腔镜袖状胃切除术（LSG）失败后的减重手术翻修对减重外科医生来说是一项临床挑战。在选择合适的翻修手术（腹腔镜胃旁路术（LGB）、腹腔镜再次袖状胃切除术（LRSG）或其他手术干预（OSI））以解决体重反弹方面，现有证据有限。我们系统地回顾了文献，以评估现有翻修手术的疗效。完成了对电子数据库（如Medline、Embase、Scopus、Web of Science和Cochrane图书馆）的全面检索。纳入了所有随机对照试验、非随机对照研究和病例系列。确定了11项主要研究（218例患者）并纳入系统评价。研究分为三大类：LGB、LRSG和OSI。术前体重指数（BMI）分别为41.9kg/m²（LGB）、38.5kg/m²（LRSG）和44.4kg/m²（OSI）。转为LGB后，随访12个月和24个月时BMI分别降至33.7和35.7kg/m²。同期的超重减轻（EWL）分别为60%和48%。LRSG后，12个月和24个月时BMI分别降至30.4和35.3kg/m²，相应的EWL分别为68%和44%。OSI后，24个月随访时BMI降至27.3kg/m²，EWL为75%，但由于主要研究中数据收集不完整而无法进行分析。LGB和LRSG在LSG失败后均能有效减重。LRSG技术难度较低，可能应用更广泛。需要进一步研究以确定长期减重益处的可持续性。
