Yeung Louise, Durkan Brandice, Barrett Allison, Kraft Cary, Vu Kim, Phillips Edward, Cunneen Scott, Burch Miguel
Department of Surgery, Cedars-Sinai Medical Center, 8635 W 3rd St, MOT, Suite 795 W, Los Angeles, CA, 90048, USA.
Department of Surgery, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA.
Surg Endosc. 2016 Jun;30(6):2244-50. doi: 10.1007/s00464-015-4498-x. Epub 2015 Sep 3.
Laparoscopic adjustable gastric banding (LAGB) is increasingly requiring revisional surgery for complications and failures. Removal of the band and conversion to either laparoscopic Roux-en-y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) is feasible as a single-stage procedure. The objective of this study is to compare the safety and efficacy of single-stage revision from LAGB to either LRYGB or LSG at 6 and 12 months postoperatively.
Retrospective analysis was performed on patients undergoing single-stage revision between 2009 and 2014 at a single academic medical center. Patients were reassessed for weight loss and complications at 6 and 12 months postoperatively.
Thirty-two patients underwent single-stage revision to LRYGB, and 72 to LSG. Preoperative BMIs were similar between the two groups (p = 0.27). Median length of stay for LRYGB was 3 days versus 2 for LSG (p = 0.14). Four patients in the LRYGB group required reoperation within 30 days, and two patients in the LSG group required reoperation within 30 days (p = 0.15). There was no difference in ER visits (p = 0.24) or readmission rates (p = 0.80) within 30 days of operation. Six delayed complications were seen in the LSG group with three requiring intervention. At 6 months postoperatively, percent excess weight loss (%EWL) was 50.20 for LRYGB and 30.64 for LSG (p = 0.056). At 12 months, %EWL was 51.19 for LRYGB and 34.89 for LSG (p = 0.31). There was no difference in diabetes or hypertension medication reduction at 12 months between LRYGB and LSG (p > 0.07).
Single-stage revision from LAGB to LRYGB or LSG is technically feasible, but not without complications. The complications in the bypass group were more severe. There was no difference in readmission or reoperation rates, weight loss or comorbidity reduction. Revision to LRYGB trended toward higher rate and greater severity of complications with equivalent weight loss and comorbidity reduction.
腹腔镜可调节胃束带术（LAGB）因并发症和手术失败而越来越需要进行翻修手术。将束带移除并转换为腹腔镜 Roux-en-y 胃旁路术（LRYGB）或腹腔镜袖状胃切除术（LSG）作为一期手术是可行的。本研究的目的是比较 LAGB 一期翻修至 LRYGB 或 LSG 术后 6 个月和 12 个月时的安全性和有效性。
对 2009 年至 2014 年在单一学术医疗中心接受一期翻修手术的患者进行回顾性分析。在术后 6 个月和 12 个月时对患者的体重减轻情况和并发症进行重新评估。
32 例患者接受了 LRYGB 一期翻修手术，72 例接受了 LSG 一期翻修手术。两组患者术前的体重指数相似（p = 0.27）。LRYGB 组的中位住院时间为 3 天，而 LSG 组为 2 天（p = 0.14）。LRYGB 组有 4 例患者在 30 天内需要再次手术，LSG 组有 2 例患者在 30 天内需要再次手术（p = 0.15）。术后 30 天内急诊就诊率（p = 0.24）或再入院率（p = 得0.80）没有差异。LSG 组出现 6 例延迟并发症，其中 3 例需要干预。术后 6 个月时，LRYGB 组的超重体重减轻百分比（%EWL）为 50.20，LSG 组为 30.64（p = 0.056）。术后 12 个月时，LRYGB 组的%EWL 为 51.19，LSG 组为得34.89（p = 0.31）。LRYGB 组和 LSG 组在术后 12 个月时糖尿病或高血压药物减少情况没有差异（p > 0.07）。
LAGB 一期翻修至 LRYGB或 LSG 在技术上是可行的，但并非没有并发症。旁路手术组的并发症更严重。再入院率、再次手术率、体重减轻情况或合并症减少情况没有差异。翻修至 LRYGB 时并发症的发生率和严重程度有升高趋势，而体重减轻情况和合并症减少情况相当。
