腹腔镜再袖状胃切除术治疗袖状胃切除术后体重反弹。
Laparoscopic re-sleeve gastrectomy as a treatment of weight regain after sleeve gastrectomy.
机构信息
Giovanni Cesana, Matteo Uccelli, Francesca Ciccarese, Domenico Carrieri, Giorgio Castello, Stefano Olmi, Department of General and Oncologic Surgery, Centre of Laparoscopic and Bariatric Surgery, Istituti Ospedalieri Bergamaschi-Policlinico San Marco, 24040 Zingonia-Osio Sotto, Italy.
出版信息
World J Gastrointest Surg. 2014 Jun 27;6(6):101-6. doi: 10.4240/wjgs.v6.i6.101.
AIM
To evaluate laparoscopic re-sleeve gastrectomy as a treatment of weight regain after Sleeve.
METHODS
Laparoscopic sleeve gastrectomy is a common bariatric procedure. Weight regain after long-term follow-up is reported. Patients were considered for laparoscopic re-sleeve gastrectomy when we observed progressive weight regain and persistence of comorbidities associated with evidence of dilated gastric fundus and/or antrum on upper gastro-intestinal series. Follow-up visits were scheduled at 1, 3, 6 and 12 mo after surgery and every 6 mo thereafter. Measures of change from baseline at different times were analyzed with the paired samples t test.
RESULTS
We observed progressive weight regain after sleeve in 11 of the 201 patients (5.4%) who had a mean follow-up of 21.1 ± 9.7 mo (range 6-57 mo). Three patients started to regain weight after 6 mo following Sleeve, 5 patients after 12 mo, 3 patients after 18 m. Re-sleeve gastrectomy was always performed by laparoscopy. The mean time of intervention was 55.8 ± 29.1 min. In all cases, neither intra-operative nor post-operative complications occurred. After 1 year follow-up we observed a significant (P < 0.05) mean body mass index reduction (-6.6 ± 2.7 kg/m(2)) and mean % excess weight loss (%EWL) increase (+31.0% ± 15.8%). An important reduction of antihypertensive drugs and hypoglycemic agents was observed after re-sleeve in those patients affected by hypertension and diabetes. Joint problems and sleep apnea syndrome improved in all 11 patients.
CONCLUSION
Laparoscopic re-sleeve gastrectomy is a feasible and effective intervention to correct weight regain after sleeve.
目的
评估腹腔镜再袖状胃切除术治疗袖状胃切除术后体重反弹。
方法
腹腔镜袖状胃切除术是一种常见的减重手术。长期随访后报道了体重反弹。当我们观察到体重持续增加且与胃底和/或胃窦扩张相关的合并症持续存在，并在上消化道系列检查中发现胃底和/或胃窦扩张时，考虑对患者进行腹腔镜再袖状胃切除术。术后随访分别在术后 1、3、6 和 12 个月进行，并在此后每 6 个月进行一次。使用配对样本 t 检验分析不同时间点与基线相比的变化。
结果
我们观察到 201 例患者中有 11 例（5.4%）在接受平均 21.1 ± 9.7 个月（6-57 个月）的随访后出现袖状胃切除术后渐进性体重反弹。3 例患者在袖状胃切除术后 6 个月开始体重增加，5 例患者在 12 个月后，3 例患者在 18 个月后。再次进行腹腔镜袖状胃切除术。干预的平均时间为 55.8 ± 29.1 分钟。所有病例均无术中或术后并发症发生。1 年随访时，我们观察到 BMI 显著降低（-6.6 ± 2.7 kg/m2），%EWL 显著增加（+31.0% ± 15.8%），差异均有统计学意义（P < 0.05）。在接受再袖状胃切除术后，高血压和糖尿病患者的降压药和降糖药用量显著减少。11 例患者的关节问题和睡眠呼吸暂停综合征均得到改善。
结论
腹腔镜再袖状胃切除术是治疗袖状胃切除术后体重反弹的一种可行且有效的干预措施。
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