初次与再次胃旁路术治疗胃束带术失败的术后安全性相似。

Similar postoperative safety between primary and revisional gastric bypass for failed gastric banding.

机构信息

Department of General, Digestive, and Metabolic Surgery, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.

Department of Nutrition, Ambroise Paré University Hospital, Versailles Saint-Quentin University, Assistance Publique-Hôpitaux de Paris, Boulogne-Billancourt, France.

出版信息

JAMA Surg. 2014 Aug;149(8):780-6. doi: 10.1001/jamasurg.2014.625.

DOI:10.1001/jamasurg.2014.625

PMID:25074013

Abstract

IMPORTANCE

Adjustable gastric bands are widely used because of low postoperative morbidity, but their long-term results are poor, often leading to revisional surgery.

OBJECTIVE

To assess the safety of revisional procedures by comparing the 30-day outcomes of primary gastric bypass vs revisions following failed adjustable gastric banding.

DESIGN, SETTING, AND PARTICIPANTS: Retrospective review using logistic regression models to compute odds ratios (95% CIs) across preoperative body mass index (calculated as weight in kilograms divided by height in meters squared) quartiles to evaluate the risk for major adverse outcomes at 30 days (death, venous thromboembolism, reinterventions, and failure to be discharged). The prospective database of a single university surgical center in Paris, France, was queried for clinical and other relevant data among all patients undergoing primary or revisional laparoscopic gastric bypass between January 1, 2004, and June 30, 2013.

MAIN OUTCOMES AND MEASURES

The primary outcome was a comparison between 30-day outcomes of primary gastric bypass and procedures following failed adjustable gastric banding.

RESULTS

In total, 831 patients had a primary procedure (group 1), and 177 patients had a secondary procedure after failed adjustable gastric banding (group 2). Overall, 78.7% of patients were female, the mean (SD) patient age was 42.6 (11.6) years, the mean (SD) body mass index was 47.6 (7.6), and mortality at 30 days was 0.5%. The rates of major adverse outcomes were similar in group 1 (7.8%) and group 2 (8.5%) (P = .77). In multivariate analyses, odds ratios for major adverse outcomes across preoperative body mass index quartiles (<42, 42-46, >46 to 52, and >52) were 1.00, 0.39 (95% CI, 0.20-0.77; P = .006), 0.55 (95% CI, 0.30-1.02; P = .06), and 0.50 (95% CI, 0.27-0.94; P = .03), respectively.

CONCLUSIONS AND RELEVANCE

The 30-day major adverse outcome rates were similar for primary gastric bypass and for procedures following failed adjustable gastric banding. Long-term comparative studies are required to better understand the quadratic relationship between body mass index and early postoperative outcomes.

摘要

重要性

由于术后发病率低，可调胃束带被广泛应用，但它们的长期效果不佳，往往导致需要进行修正手术。

目的

通过比较初次胃旁路术与失败的可调胃束带修复术的 30 天结果，评估修复手术的安全性。

设计、地点和参与者：使用逻辑回归模型对术前体重指数（计算为体重除以身高的平方）四分位数进行比较，计算主要不良结局（30 天内死亡、静脉血栓栓塞、再次干预和未能出院）的风险比（95%CI），以回顾性分析法国巴黎一所大学外科中心的前瞻性数据库中 2004 年 1 月 1 日至 2013 年 6 月 30 日期间所有接受初次或修正腹腔镜胃旁路术的患者的临床和其他相关数据。

主要结局和测量指标

主要结局为初次胃旁路术与失败的可调胃束带修复术后 30 天结果的比较。

结果

共有 831 例患者接受了初次手术（第 1 组），177 例患者在可调胃束带失败后接受了二次手术（第 2 组）。总体而言，78.7%的患者为女性，患者平均（SD）年龄为 42.6（11.6）岁，平均（SD）体重指数为 47.6（7.6），30 天死亡率为 0.5%。第 1 组（7.8%）和第 2 组（8.5%）的主要不良结局发生率相似（P=0.77）。多变量分析显示，术前体重指数四分位数（<42、42-46、>46-52 和>52）的主要不良结局比值比分别为 1.00、0.39（95%CI，0.20-0.77；P=0.006）、0.55（95%CI，0.30-1.02；P=0.06）和 0.50（95%CI，0.27-0.94；P=0.03）。