Samakar Kamran, McKenzie Travis J, Kaberna James, Tavakkoli Ali, Vernon Ashley H, Madenci Arin L, Shikora Scott A, Robinson Malcolm K
Department of General and GI Surgery, University of Southern California, 1510 San Pablo Street, Suite 514, Los Angeles, CA, 90033-4612, USA.
Department of General Surgery, Mayo Clinic, Rochester, MN, USA.
Surg Endosc. 2016 Dec;30(12):5453-5458. doi: 10.1007/s00464-016-4905-y. Epub 2016 Apr 29.
We conducted the following study to evaluate the safety and efficacy of single-stage conversion of failed laparoscopic adjustable gastric band (LAGB) to laparoscopic Roux-en-Y gastric bypass (LRYGB) as compared to a cohort of primary LRYGB patients.
A single-institution, prospectively maintained bariatric database was used to retrospectively identify consecutive patients who underwent single-stage removal of LAGB with concomitant conversion to LRYGB between the years of 2007 and 2013. The study cohort was matched 1:1 for age, gender, body mass index (BMI), and approximate date of operation to patients who underwent primary LRYGB. Primary endpoints were operative time, complication rate, length of hospital stay (LOS), and percent excess BMI lost (%EBMIL) at 24-month follow-up.
Ninety-four conversion patients met inclusion criteria. There were no statistically significant differences in the mean LOS (3.1 vs. 3.0 days, p = 0.97) or the major complication rate (3.2 vs. 1.1 %, p = 0.62) at 30 days postoperatively. Likewise, 30-day minor complication rates, including readmission, were similar between groups (7.5 vs. 6.4 %, p = 0.77). The average operative time was significantly longer for conversion compared to primary LRYGB (193.5 vs. 132 min; p < 0.01). At most recent follow-up after conversion or primary LRYGB, median %EBMIL was 61.3 and 77.3 % (p < 0.01), percent total weight loss was 23.6 and 30.5 % (p < 0.01), and percent change in BMI was 23.4 and 30.5 % (p < 0.01), respectively. Median follow-up time was 17 and 18.6 months after conversion and primary LRYGB, respectively.
Single-stage conversion of LAGB to LRYGB is safe with an acceptable complication rate and similar LOS compared to primary LRYGB.
我们开展了以下研究，旨在评估将失败的腹腔镜可调节胃束带术（LAGB）单阶段转换为腹腔镜Roux-en-Y胃旁路术（LRYGB）的安全性和有效性，并与一组初次接受LRYGB手术的患者进行比较。
利用一个单机构前瞻性维护的肥胖症数据库，回顾性确定2007年至2013年间连续接受LAGB单阶段移除并同时转换为LRYGB的患者。研究队列在年龄、性别、体重指数（BMI）和手术大致日期方面与接受初次LRYGB手术的患者按1:1进行匹配。主要终点指标为手术时间、并发症发生率、住院时间（LOS）以及随访24个月时的超重BMI丢失百分比（%EBMIL）。
94例转换患者符合纳入标准。术后30天的平均住院时间（3.1天对3.0天，p = 0.97）或主要并发症发生率（3.2%对1.1%，p = 0.62）无统计学显著差异。同样，两组的30天轻微并发症发生率（包括再入院率）相似（7.5%对6.4%，p = 0.77）。与初次LRYGB相比，转换手术的平均手术时间明显更长（193.5分钟对132分钟；p < 0.01）。在转换手术或初次LRYGB后的最近一次随访中，%EBMIL中位数分别为61.3%和77.3%（p < 0.01），总体体重减轻百分比分别为23.6%和30.5%（p < 0.01），BMI变化百分比分别为23.4%和30.5%（p < 0.01）。转换手术和初次LRYGB后的中位随访时间分别为17个月和18.6个月。
LAGB单阶段转换为LRYGB是安全的，并发症发生率可接受，且与初次LRYGB相比住院时间相似。
