Navez Julie, Dardamanis Dimitrios, Thissen Jean-Paul, Navez Benoit
Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200, Brussels, Belgium,
Obes Surg. 2015 May;25(5):812-7. doi: 10.1007/s11695-014-1473-x.
Vertically banded gastroplasty or adjustable gastric banding often result in weight regain, complications, or side effects. Failed restrictive bariatric procedures can be converted in revisional laparoscopic Roux-en-Y gastric bypass (LRYGB). This study aimed to compare weight loss, evolution of comorbidities, and quality of life (QOL) between primary versus revisional LRYGB.
Between 2004 and 2012, 374 patients underwent LRYGB as primary or revisional surgery performed by a single surgeon. Patient data were retrospectively reviewed; questionnaires of QOL were sent to all patients. Outcomes were evaluated according to Bariatric Analysis and Reporting Outcome System (BAROS) taking into account excess body mass index loss (EBMIL), correction of comorbidities, improvement in QOL, and complications.
Two hundred thirty-two patients (62%) responded to the questionnaire, 163 patients in the primary group and 69 in the revisional group. Median follow-up was 36 months (12-108). Median percentages of EBMIL were, respectively, 74% (26.8-126.8) and 50% (-31.6-124.2) in the primary and the revisional groups (p < 0.01). Median BAROS score reached 6.5 (-2-9) in the primary group, against 4.3 (-1.8-9) in the revisional group (p < 0.01). There were significantly less "fair" and more "excellent" scores in the primary group, considering initial BMI before gastroplasty. Arterial hypertension and sleep apnea syndrome resolved, respectively, in 51 and 56% in the primary group and only in 29 and 33% in the revisional group (p < 0.01).
According to BAROS score, revisional LRYGB for failed restrictive procedures provided poorer results than primary LRYGB in terms of weight loss, resolution of comorbidities and QOL.
垂直束带胃成形术或可调节胃束带术常常导致体重反弹、并发症或副作用。失败的限制性减肥手术可转换为腹腔镜Roux-en-Y胃旁路术（LRYGB）进行翻修。本研究旨在比较初次与翻修LRYGB术后的体重减轻情况、合并症的演变以及生活质量（QOL）。
2004年至2012年间，374例患者接受了由同一位外科医生实施的初次或翻修LRYGB手术。对患者数据进行回顾性分析；向所有患者发送生活质量问卷。根据减肥分析和报告结果系统（BAROS）评估结果，同时考虑多余体重指数降低（EBMIL）、合并症的纠正、生活质量的改善以及并发症情况。
232例患者（62%）回复了问卷，其中初次手术组163例，翻修手术组69例。中位随访时间为36个月（12 - 108个月）。初次手术组和翻修手术组的EBMIL中位数百分比分别为74%（26.8 - 126.8）和50%（-31.6 - 124.2）（p < 0.01）。初次手术组的BAROS中位评分达到6.5（-2 - 9），而翻修手术组为4.3（-1.8 - 9）（p < 0.01）。考虑胃成形术前的初始体重指数，初次手术组“良好”评分显著更少，“优秀”评分更多。初次手术组中，动脉高血压和睡眠呼吸暂停综合征的缓解率分别为51%和56%，而翻修手术组仅为29%和33%（p < 0.01）。
根据BAROS评分，对于失败的限制性手术进行翻修的LRYGB在体重减轻、合并症的缓解以及生活质量方面的效果比初次LRYGB差。
