David Matan Ben, Abu-Gazala Samir, Sadot Eran, Wasserberg Nir, Kashtan Hanoch, Keidar Andrei
Department of Surgery Rabin Medical Center, Campus Beilinson, Petach Tiqva, Israel.
Department of Surgery, Hadassah Hebrew University Medical Center, Ein Kerem, Jerusalem, Israel.
Surg Obes Relat Dis. 2015 Sep-Oct;11(5):1085-91. doi: 10.1016/j.soard.2015.01.026. Epub 2015 Feb 11.
The Silastic ring vertical gastroplasty (SRVG), a modification of Mason's vertical banded gastroplasty (VBG), was the restrictive procedure of choice for many bariatric surgeons. The reoperation rate for failure/complications reported in long-term studies is approximately 50%.
We report our experience in laparoscopic conversion of failed SRVG to Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD).
A single surgeon's experience at a university-affiliated hospital.
Between March 2006 and April 2014, 39 patients underwent conversion of SRVG to laparoscopic RYGB (n = 25) or BPD (n = 14). The outcomes were retrieved from a prospectively collected database and analyzed.
Most (89%) of the conversions were completed laparoscopically. The mean operative time was 195 and 200 min for RYGB and BPD, respectively. There was no mortality. Complications occurred in 11 patients (28%), 5 in RYGB (19%) and 6 in BPD (42%). At the 3-year follow-up, the mean body mass index decreased from 47±8 kg/m(2) to 26±4 kg/m(2) for BPD, and from 43 kg/m(2) to 34 kg/m(2) (P = .05) for RYGB. Weight (kg) decreased from 110 to 84 and to 92, and from 123 to 81 and 68, at 1 and 3 years for RYGB and BPD, respectively.
The weight loss for RYGB and BPD was equal at 1 year but tended to be better for BPD at 3 years postoperatively. Laparoscopic conversion of failed VBG to RYGB or BPD was feasible, but it was followed by prohibitively high complication rates in BPD patients. The risk:benefit ratio of these procedures in this series is questionable.
硅橡胶环垂直胃成形术（SRVG）是梅森垂直束带胃成形术（VBG）的一种改良术式，曾是许多减肥外科医生选择的限制性手术方法。长期研究报道的因手术失败/并发症而进行再次手术的比例约为50%。
我们报告腹腔镜下将失败的SRVG转换为 Roux-en-Y 胃旁路术（RYGB）和胆胰转流术（BPD）的经验。
一所大学附属医院中一位外科医生的经验。
2006年3月至2014年4月期间，39例患者接受了将SRVG转换为腹腔镜RYGB（n = 25）或BPD（n = 14）的手术。从一个前瞻性收集的数据库中获取结果并进行分析。
大多数（89%）转换手术通过腹腔镜完成。RYGB和BPD的平均手术时间分别为195分钟和200分钟。无死亡病例。11例患者（28%）出现并发症，RYGB组5例（19%），BPD组6例（42%）。在3年随访时，BPD组的平均体重指数从47±8 kg/m²降至26±4 kg/m²，RYGB组从43 kg/m²降至34 kg/m²（P = 0.05）。RYGB组和BPD组在1年和3年时体重（kg）分别从123降至81和68，从110降至84和92。
RYGB和BPD在术后1年的体重减轻效果相当，但术后3年BPD的效果往往更好。将失败的VBG腹腔镜转换为RYGB或BPD是可行的，但BPD患者的并发症发生率高得令人望而却步。本系列中这些手术的风险效益比值得怀疑。
