Aarts Edo, Koehestanie Parweez, Dogan Kemal, Berends Frits, Janssen Ignace
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Surg Obes Relat Dis. 2014 Nov-Dec;10(6):1077-83. doi: 10.1016/j.soard.2014.07.006. Epub 2014 Jul 14.
The most performed restrictive bariatric procedure is the laparoscopic adjustable gastric band (LAGB). With many patients still receiving a LAGB in Europe and the United States, inevitably, the number of complications also increases. For many complications revisional bariatric surgery is necessary. In this study, the outcomes of one-stage LAGB conversion to a Roux-en-Y gastric bypass (RYGB) at our institution are presented. The objective of this study was to investigate the safety and efficiency of RYGB performed as a one-stage procedure after failed LAGB.
Patients were retrospectively selected using a prospectively collected database. The gastric band had to be in situ for at least 1 year and minimum postoperative follow-up was 12 months. The revisional RYGB had to be performed as a 1-step procedure.
A total of 195 patients were included while 3 were lost to follow up. Overall, 178 (91%) procedures were performed without perioperative complications, and only 8 (4%) patients required reoperation within 30 days. The mean follow-up was 40 months (±24) after RYGB. Mean excess weight loss (EWL) increased from 25% (±26/-50- 120%) to 60% (±21.2/0- 130), 65% (±23.5/0- 131), 63% (±24.2/2- 132), 60% (±24.1/0- 111) and 53% (±28.7/-39- 109) in the first 5 postoperative years.
Converting a gastric band to a RYGB in a one-stage procedure is safe and feasible, with acceptable complication rates when performed in a specialized institution. The RYGB conversion results in a good EWL of 65% after 2 years. However, proper patient selection is of the utmost importance.
最常用的限制性减肥手术是腹腔镜可调节胃束带术（LAGB）。在欧洲和美国，仍有许多患者接受LAGB手术，不可避免地，并发症的数量也会增加。对于许多并发症，需要进行减肥修正手术。在本研究中，介绍了在我们机构进行的一期LAGB转换为 Roux-en-Y 胃旁路术（RYGB）的结果。本研究的目的是调查在LAGB失败后作为一期手术进行的RYGB的安全性和有效性。
使用前瞻性收集的数据库对患者进行回顾性选择。胃束带必须在位至少1年，术后最短随访时间为12个月。修正性RYGB必须作为一步手术进行。
共纳入195例患者，3例失访。总体而言，178例（91%）手术无围手术期并发症，仅8例（4%）患者在30天内需要再次手术。RYGB术后平均随访时间为40个月（±24）。术后前5年，平均超重减轻（EWL）从25%（±26/-50 - 120%）增加到60%（±21.2/0 - 130）、65%（±23.5/0 - 131）、63%（±24.2/2 - 132）、60%（±24.1/0 - 111）和53%（±28.7/-39 - 109）。
在专门机构进行一期手术将胃束带转换为RYGB是安全可行的，并发症发生率可接受。RYGB转换术后2年的EWL良好，可达65%。然而，正确的患者选择至关重要。
