Department of Surgery, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, the Netherlands.
Obes Surg. 2017 Jan;27(1):83-89. doi: 10.1007/s11695-016-2249-2.
Roux-en-Y gastric bypass (RYGB) is still considered the gold standard in bariatric surgery. Before, adjustable gastric banding (AGB) was regarded as an alternative; nowadays, sleeve gastrectomy (SG) is a more favorable alternative. In case of unsatisfactory results, RYGB is often performed as a secondary procedure. Conversion of an AGB is associated with a high risk of complications; the hypothesis was that this would be less after conversion of an SG.
All patients undergoing conversion to RYGB after AGB or SG between 2005 and 2012 were included for retrospective analysis. Patient characteristics, operative details, postoperative complications, the relief of complaints, weight loss, reasons for failure, and evolution of known comorbidities up to 2 years were analyzed.
A total of 178 patients were included (79.8 % female): AGB 110 (61.8 %) versus SG 68 (38.2 %). Main reasons for conversion were weight regain/insufficient weight loss (48.4 %) or dysphagia/reflux complaints (39.9 %). Surgical complications were found in 19 patients (AGB 13 vs SG 6; p = 0.530). Infectious complications occurred in 13 patients (AGB 11 vs SG 2; p = 0.135). Total body weight loss was equal between groups after 2 years (AGB 31.6 ± 11.0 % vs SG 31.6 ± 12.0 %; p = 0.998). Similar results were found in a subgroup analysis on patients undergoing conversion for additional weight loss (AGB 31.7 ± 11.7 % vs SG 27.0 ± 13.1 %; p = 0.173).
Conversion to RYGB after failed AGB or SG showed comparable short-term results in terms of postoperative complications and weight loss.
Roux-en-Y 胃旁路术（RYGB）仍然被认为是减重手术的金标准。在过去，可调胃束带术（AGB）被视为一种替代方法；而如今，袖状胃切除术（SG）则是一种更受欢迎的替代方法。如果手术结果不理想，RYGB 通常作为二次手术进行。AGB 转换存在较高的并发症风险；假设 SG 转换的风险会较低。
回顾性分析了 2005 年至 2012 年间行 AGB 或 SG 后行 RYGB 转换的所有患者。分析患者特征、手术细节、术后并发症、症状缓解、体重减轻、失败原因以及截至 2 年时已知合并症的演变情况。
共纳入 178 例患者（79.8%为女性）：AGB 110 例（61.8%），SG 68 例（38.2%）。转换的主要原因是体重反弹/减重不足（48.4%）或吞咽困难/反流症状（39.9%）。19 例患者发生手术并发症（AGB 13 例 vs. SG 6 例；p=0.530）。13 例患者发生感染性并发症（AGB 11 例 vs. SG 2 例；p=0.135）。2 年后两组的总体体重减轻量相当（AGB 31.6±11.0% vs. SG 31.6±12.0%；p=0.998）。在进一步减重的患者亚组分析中也得到了相似的结果（AGB 31.7±11.7% vs. SG 27.0±13.1%；p=0.173）。
AGB 或 SG 失败后行 RYGB 转换在术后并发症和体重减轻方面具有相似的短期结果。
