El Chaar Maher, Stoltzfus Jill, Claros Leonardo, Miletics Maureen
Department of Surgery, Division of Bariatric and Minimally Invasive Surgery, the Medical School of Temple University/St Luke's University Health Network, 1736 Hamilton Boulevard, Allentown, PA, 18104, USA.
Research Institute, St Luke's University Health Network, 801 Ostrum Street, Bethlehem, PA, 18105, USA.
J Gastrointest Surg. 2017 Jan;21(1):12-16. doi: 10.1007/s11605-016-3215-y. Epub 2016 Aug 30.
Bariatric surgery is the only proven and effective long-term treatment for morbid obesity, with laparoscopic sleeve gastrectomy (LSG) being the most commonly performed weight loss procedure in the USA. Despite its safety and efficacy, LSG's association with both de novo and pre-existing gastroesophageal reflux disease (GERD) remains controversial.
Therefore, this retrospective study determined the incidence, indications, and outcomes of revisional surgery following LSG in adult patients at our institution from 2010 to 2014. Descriptive outcomes are reported due to the small sample size.
Of the 630 LSGs performed, 481 patients were included in the analysis (mean age and BMI = 46.2 and 44.3, respectively; 79.5 % female; 82.3 % white). A total of 12/481 patients underwent conversion to a different bariatric procedure due to inadequate weight loss, GERD, or both. The 6/12 patients with GERD-related symptoms and failed medical management underwent conversion to Roux-en-Y gastric bypass (RYBG) following preoperative wireless Bravo pH monitoring (Given Imaging) to confirm the diagnosis objectively. The other 6/12 patients with inadequate weight loss received either RYBG or bilio-pancreatic diversion with duodenal switch (BPD/DS) based on personal choice. Overall, 9/12 patients underwent conversion to RYBG, and 3/12 underwent conversion to BPD/DS. Median time from the initial surgery to conversion was 27 months (range 17-41). Median operating room time was 168 min (range 130-268). Median length of stay was 48 h (range 24-72). The follow-up rate at 3 months was 100 % (12/12 patients).
Our study showed that some patients may present following LSG with refractory GERD or inadequate weight loss, but that conversion to RYBG or BPD/DS may be done safely and effectively.
减重手术是唯一经证实有效的病态肥胖长期治疗方法，腹腔镜袖状胃切除术（LSG）是美国最常用的减肥手术。尽管LSG具有安全性和有效性，但其与新发和既往存在的胃食管反流病（GERD）的关联仍存在争议。
因此，这项回顾性研究确定了2010年至2014年在本机构接受LSG手术的成年患者再次手术的发生率、适应证和结果。由于样本量小，报告了描述性结果。
在实施的630例LSG手术中，481例患者纳入分析（平均年龄和BMI分别为46.2和44.3；79.5%为女性；82.3%为白人）。共有12/481例患者因减重不足、GERD或两者兼而有之而转为其他减重手术。6/12例有GERD相关症状且药物治疗无效的患者，在术前进行无线Bravo pH监测（Given Imaging）以客观证实诊断后，转为Roux-en-Y胃旁路术（RYBG）。其他6/12例减重不足的患者根据个人选择接受了RYBG或胆胰转流十二指肠转位术（BPD/DS）。总体而言，9/12例患者转为RYBG，3/12例患者转为BPD/DS。从初次手术到再次手术的中位时间为27个月（范围17 - 41个月）。中位手术时间为168分钟（范围130 - 268分钟）。中位住院时间为48小时（范围24 - 72小时）。3个月时的随访率为100%（12/12例患者）。
我们的研究表明，一些患者在接受LSG手术后可能出现难治性GERD或减重不足的情况，但转为RYBG或BPD/DS可能是安全有效的。
