Uittenbogaart Martine, Leclercq Wouter Kg, Luijten Arijan Apm, van Dielen Francois Mh
Obesity Center Máxima, Department of Surgery, Máxima Medical Center, De Run 4600, 5504 DB, Veldhoven, the Netherlands.
Obes Surg. 2017 Feb;27(2):381-386. doi: 10.1007/s11695-016-2283-0.
Roux-en-Y gastric bypass (RYGB) is associated with approximately 25 % weight loss failure, resulting in insufficient weight loss or weight regain. Strategies of revisional surgery focus on alteration of limb length, pouch or stoma size. Altering pouch size and outlet by adding laparoscopic adjustable gastric band (LAGB) might initiate further weight loss. The goal of this study is to review the safety and efficacy of LAGB after failed RYGB in a retrospective cohort of patients in our institute.
Patients with secondary LAGB (n = 44) were studied between May 2012 and January 2015. Demographics, effects on weight loss and complications were analysed.
Mean age and body mass index (BMI) at time of LAGB was 45.8 ± 8.2 years and 37.2 ± 5.4 kg/m, respectively. Mean interval between RYGB and LAGB was 2.6 ± 1.3 years. Mean follow-up was 14 ± 7.9 months, with 25 % loss to follow-up at 12 months. Due to LAGB, patients lost an additional 17.6 % ± 28.3 % excess weight. Patients with weight regain after initial weight loss success showed more excess weight loss (EWL) compared to patients whom never reached 50% EWL after RYGB. Overall complication and reoperation rates were 30 and 21 %, respectively, with 16 % band removal. One fatality due to septic shock following band erosion was observed.
In this largest published cohort, secondary banding of failed RYGB provides only limited additional weight loss. Furthermore, this technique is associated with high morbidity and reoperation rates. A significant difference in effect was found between patients with weight loss failure and weight regain. Larger prospective series are necessary to evaluate if the modest benefits are worth the risks of secondary LAGB.
Roux-en-Y胃旁路术（RYGB）约有25%的减重失败率，导致减重不足或体重反弹。翻修手术策略主要集中在改变肠袢长度、胃囊或吻合口大小。通过增加腹腔镜可调节胃束带（LAGB）来改变胃囊大小和出口可能会引发进一步减重。本研究的目的是回顾我院一组回顾性队列中RYGB失败后LAGB的安全性和有效性。
对2012年5月至2015年1月期间接受二次LAGB手术的患者（n = 44）进行研究。分析了人口统计学资料、对减重的影响及并发症情况。
LAGB手术时的平均年龄和体重指数（BMI）分别为45.8±8.2岁和37.2±5.4kg/m²。RYGB与LAGB之间的平均间隔时间为2.6±1.3年。平均随访时间为14±7.9个月，12个月时随访失访率为25%。由于LAGB手术，患者额外减重17.6%±28.3%的超重体重。初始减重成功后体重反弹的患者比RYGB术后未达到50%超重体重减轻（EWL）的患者减重更多。总体并发症发生率和再次手术率分别为30%和21%，束带移除率为16%。观察到1例因束带侵蚀导致感染性休克死亡。
在该已发表的最大队列研究中，RYGB失败后的二次束带术仅能带来有限的额外减重效果。此外，该技术与高发病率和再次手术率相关。减重失败和体重反弹的患者在效果上存在显著差异。需要更大规模的前瞻性系列研究来评估这种适度的益处是否值得承担二次LAGB手术的风险。
