袖状胃切除术转为 Roux-en-Y 胃旁路术：34 例患者的审计
Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: an audit of 34 patients.
作者信息
Poghosyan Tigran, Lazzati Andrea, Moszkowicz David, Danoussou Divya, Vychnevskaia Karina, Azoulay Daniel, Czernichow Sebastien, Carette Claire, Bouillot Jean-Luc
机构信息
AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; UVSQ, UFR des sciences de la santé Simone Veil, 78180, Montigny-le-Bretonneux, France.
Department of Digestive and Bariatric Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
出版信息
Surg Obes Relat Dis. 2016 Nov;12(9):1646-1651. doi: 10.1016/j.soard.2016.02.039. Epub 2016 Mar 2.
BACKGROUND
Weight loss failure and proton pomp inhibitor (PPI)-resistant gastroesophageal reflux diseases (GERD) after sleeve gastrectomy (SG) are frequently encountered.
OBJECTIVES
The aim of this study was to evaluate the efficacy and risks of SG conversion to Roux-en-Y gastric bypass (RYGB) in the case of weight loss failure or severe GERD.
SETTING
University hospitals.
METHODS
Between March 2007 and December 2014, 34 patients with history of SG underwent RYGP. A retrospective analysis of a prospectively collected database was undertaken.
RESULTS
Among 34 patients, 31 underwent revisional surgery for weight loss failure and 3 for PPI-resistant GERD. Six patients in the weight loss failure group had symptomatic GERD that was effectively treated with PPIs. The average body mass index (BMI) was 53±11 kg/m2 before SG. A laparoscopic approach was performed in 94% of patients. There was no postoperative mortality. Major adverse events (<90 days) occurred in 4 patients (11.7%). The mean length of stay was 6.7±2.8 days. At the time of revisional surgery, the mean BMI, percentage excess weight loss, and percentage weight loss were 44.7±9.8 kg/m2, 33.6±27.1%, and 16±9.7%, respectively, compared with 40.9±8.5 kg/m2, 63.1±36.2%, and 23.8±14% at 3 years. The GERD was resolved in all patients, allowing the cessation of PPI medication.
CONCLUSION
Laparoscopic conversion of SG to RYGB is feasible and it allows improvement in secondary weight loss and GERD, but at the cost of high morbidity.
背景
袖状胃切除术（SG）后减肥失败以及质子泵抑制剂（PPI）抵抗的胃食管反流病（GERD）屡见不鲜。
目的
本研究旨在评估在减肥失败或严重GERD情况下，将SG转换为Roux-en-Y胃旁路术（RYGB）的疗效和风险。
地点
大学医院。
方法
2007年3月至2014年12月期间，34例有SG病史的患者接受了RYGP。对前瞻性收集的数据库进行回顾性分析。
结果
34例患者中，31例因减肥失败接受了翻修手术，3例因PPI抵抗的GERD接受了翻修手术。减肥失败组中有6例有症状的GERD患者经PPI有效治疗。SG术前平均体重指数（BMI）为53±11kg/m²。94%的患者采用了腹腔镜手术方式。无术后死亡病例。4例患者（11.7%）发生了严重不良事件（<90天）。平均住院时间为6.7±2.8天。翻修手术时，平均BMI、超重体重减轻百分比和体重减轻百分比分别为44.7±9.8kg/m²、33.6±27.1%和16±9.7%，而3年时分别为40.9±8.5kg/m²、63.1±36.2%和23.8±14%。所有患者的GERD均得到解决，可停止使用PPI药物。
结论
腹腔镜下将SG转换为RYGB是可行的，可改善二次减肥效果和GERD，但代价是高发病率。
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