Dakour Aridi Hanaa N, Wehbe Mohammad-Rachad, Shamseddine Ghassan, Alami Ramzi S, Safadi Bassem Y
Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
Obes Surg. 2017 Jun;27(6):1401-1408. doi: 10.1007/s11695-016-2529-x.
Laparoscopic adjustable gastric band (LAGB) carries a high rate of failure and reoperation. Laparoscopic conversion of failed LAGB to Roux-en-Y gastric bypass (RYGB) has been shown to be safe and feasible, but long-term follow-up data is still limited.
The aim of this study is to evaluate the safety and effectiveness of RYGB after failed LAGB in our patient population.
The setting was the University Hospital, Beirut, Lebanon.
Using a prospectively collected database, we retrospectively reviewed data of patients who underwent LAGB revision to RYGB at our institution between 2006 and 2014.
A total of 58 patients underwent RYGB after failed LAGB in our institution between 2006 and 2014. Of those, 20 patients (34.5%) had concomitant band removal while the rest underwent a two-stage RYGB after a mean of 30 months after band removal. A follow-up was achieved in 84.5, 82, 83, 95, and 76% of patients at 1, 2, 3, 4, and 5 years after RYGB. Percentage of excess weight loss (%EWL) was 62.8, 68.1, 64.2, 63.8, and 61.3% at 1, 2, 3, 4, and 5 years, respectively, while percentage of total weight loss (%TWL) was 28.4, 30.7, 29.4, 28.9, and 28.6% at the corresponding time periods. The most common short-term complications were abscesses/leaks (5.2%) while the most common long-term complications were symptomatic gallstones necessitating laparoscopic cholecystectomy (5.2%), incisional hernias (5.2%), and small-bowel obstruction (3.4%). No surgery-related mortality was recorded.
RYGB is a safe procedure with favorable weight loss outcomes at 5 years and can be considered a good rescue procedure after failed LAGB.
腹腔镜可调节胃束带术（LAGB）失败率和再次手术率较高。已证明将失败的LAGB转换为腹腔镜Roux-en-Y胃旁路术（RYGB）是安全可行的，但长期随访数据仍然有限。
本研究旨在评估在我们的患者群体中，LAGB失败后行RYGB的安全性和有效性。
黎巴嫩贝鲁特大学医院。
利用前瞻性收集的数据库，我们回顾性分析了2006年至2014年间在我们机构接受LAGB翻修为RYGB的患者数据。
2006年至2014年间，我们机构共有58例LAGB失败后接受RYGB手术的患者。其中，20例患者（34.5%）同时取出了束带，其余患者在束带取出后平均30个月接受了两阶段RYGB手术。RYGB术后1、2、3、4和5年的患者随访率分别为84.5%、82%、83%、95%和76%。术后1、2、3、4和5年的超重减轻百分比（%EWL）分别为62.8%、68.1%、64.2%、63.8%和61.3%，而相应时间段内的总体重减轻百分比（%TWL）分别为28.4%、30.7%、29.4%、28.9%和28.6%。最常见的短期并发症是脓肿/渗漏（5.2%），而最常见的长期并发症是需要腹腔镜胆囊切除术的有症状胆结石（5.2%）、切口疝（5.2%）和小肠梗阻（3.%). 未记录与手术相关的死亡病例。
RYGB是一种安全的手术，5年时减重效果良好，可被视为LAGB失败后的良好补救手术。
