Iannelli Antonio, Debs Tarek, Martini Francesco, Benichou Benjamin, Ben Amor Imed, Gugenheim Jean
Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France; Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, Hepatic Complications in Obesity, Nice, France; Faculty of Medecine, University of Nice-Sophia-Antipolis, Nice, France.
Digestive Center, Centre Hospitalier Universitaire of Nice, Nice, France.
Surg Obes Relat Dis. 2016 Sep-Oct;12(8):1533-1538. doi: 10.1016/j.soard.2016.04.008. Epub 2016 Apr 12.
Laparoscopic sleeve gastrectomy (SG) has gained popularity as a standalone procedure. However, long-term complications are reported, mainly weight loss failure and gastroesophageal reflux disease (GERD). Therefore, demand for revisional surgery is rising.
The aim of this study was to report preliminary results within the 2 main indications for laparoscopic conversion of SG to Roux-en-Y gastric bypass (RYGB).
University Hospital, France.
Data from all patients who underwent laparoscopic conversion from SG to RYGB were retrospectively analyzed as to indications for revisional surgery, weight loss, and complications.
Forty patients underwent conversion, 29 cases (72.5%) for weight loss failure and 11 cases for refractory GERD (27.5%). The mean interval from SG to RYGB was 32.6 months (range 8-113). Revisional surgery was attempted by laparoscopy in all cases, and conversion to laparotomy was necessary in 3 patients (7.5%). Mean length of follow-up was 18.6 months (range 9-60) after conversion. Follow-up rate was 100%. Mean percent total weight loss and percent excess weight loss were 34.7% and 64%, respectively, when calculated from weight before SG. Remission rate for GERD was 100%. Improvement was observed for all co-morbidities after conversion. There was no immediate postoperative mortality. The postoperative complication rate was 16.7%. According to the Clavien-Dindo classification, there were 5 grade II and 2 grade IIIa complications.
Laparoscopic conversion of SG to RYGB is safe and feasible. In the short term, it appears to be effective in treating GERD and inducing significant additional weight loss and improvement of co-morbidities.
腹腔镜袖状胃切除术（SG）作为一种独立手术已越来越受欢迎。然而，有报道称其存在长期并发症，主要是减重失败和胃食管反流病（GERD）。因此，翻修手术的需求正在增加。
本研究的目的是报告腹腔镜下将SG转换为Roux-en-Y胃旁路术（RYGB）的2个主要适应证的初步结果。
法国大学医院。
回顾性分析所有接受腹腔镜下从SG转换为RYGB的患者的数据，包括翻修手术的适应证、体重减轻情况和并发症。
40例患者接受了转换手术，其中29例（72.5%）因减重失败，11例因难治性GERD（27.5%）。从SG到RYGB的平均间隔时间为32.6个月（范围8 - 113个月）。所有病例均尝试通过腹腔镜进行翻修手术，3例患者（7.5%）需要转为开腹手术。转换后平均随访时间为18.6个月（范围9 - 60个月）。随访率为100%。从SG术前体重计算，平均总体重减轻百分比和超重减轻百分比分别为34.7%和64%。GERD的缓解率为100%。转换后所有合并症均有改善。术后无即刻死亡。术后并发症发生率为16.7%。根据Clavien-Dindo分类，有5例II级和2例IIIa级并发症。
腹腔镜下将SG转换为RYGB是安全可行的。短期内，它似乎对治疗GERD、显著增加体重减轻和改善合并症有效。
