Emous M, Apers J, Hoff C, van Beek A P, Totté E
Department of Bariatric and Metabolic Surgery, Medisch Centrum Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands,
Surg Endosc. 2015 Aug;29(8):2217-23. doi: 10.1007/s00464-014-3928-5. Epub 2014 Oct 16.
Several different procedures have been proposed as a revisional procedure for treatment of failed laparoscopic adjustable gastric banding (LAGB). Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been advocated as the procedure of choice for revision. In this study, we compare the single- and two-step approaches for the revision of failed LAGB to LRYGB.
All patients who underwent bariatric surgery were included in a prospective database. For the purpose of this study, patients who underwent revisional surgery from LAGB to LRYGB were selected. Records for individual patients were completed by data review. Complication rates and weight development were recorded until 2 years postoperatively. Data were compared between both procedures and with complications rates reported in literature.
Revisional gastric bypass surgery was performed in 257 patients. This was done as a planned single-step procedure in 220 (86 %) patients without indications for acute band removal and in 32 patients as a planned 2 step procedure. Five patients were planned as a single-step procedure but were intraoperatively converted to a 2-step procedure based on poor pouch tissue quality. No postoperative mortality occurred in both groups. No differences in early major morbidity and stricture formation were seen between the two groups. Gastric ulceration was more frequently observed after 2-steps procedure (8.5 vs. 1.7 %, p < 0.05). In comparison with data reported in literature, the single-step procedure had similar to lower complication rates. Percentage excess weight loss two years after revisional gastric bypass procedure was, respectively, 53 versus 67 % (p = 0.147) for single- and two-step procedure.
In patients without indications for acute band removal, the planned conversion of gastric banding to Roux-Y gastric bypass can be safely done in a single-step procedure without increase in morbidity and no difference in postoperative weight loss.
已经提出了几种不同的手术方法作为治疗失败的腹腔镜可调节胃束带术（LAGB）的修正手术。腹腔镜Roux-en-Y胃旁路术（LRYGB）已被提倡作为修正手术的首选方法。在本研究中，我们比较了将失败的LAGB修正为LRYGB的单步和两步方法。
所有接受减肥手术的患者都被纳入一个前瞻性数据库。为了本研究的目的，选择了接受从LAGB到LRYGB修正手术的患者。通过数据回顾完成个体患者的记录。记录并发症发生率和体重变化直至术后2年。比较两种手术方法之间的数据以及与文献报道的并发症发生率。
257例患者接受了修正性胃旁路手术。其中220例（86%）患者按计划进行单步手术，无急性束带移除指征，32例患者按计划进行两步手术。5例患者原计划进行单步手术，但术中因胃囊组织质量差而改为两步手术。两组均未发生术后死亡。两组在早期主要发病率和狭窄形成方面无差异。两步手术后胃溃疡的发生率更高（8.5%对1.7%，p<0.05）。与文献报道的数据相比，单步手术的并发症发生率相似或更低。修正性胃旁路手术后两年的超重体重减轻百分比，单步手术和两步手术分别为53%和67%（p=0.147）。
对于无急性束带移除指征的患者，将胃束带术计划转换为Roux-Y胃旁路术可通过单步手术安全完成，且不增加发病率，术后体重减轻无差异。
