Wijngaarden Leontine H, Jonker Frederik H W, van den Berg Jan W, van Rossem Charles C, van der Harst Erwin, Klaassen René A
Department of Surgery, Maasstad Hospital, Rotterdam, Netherlands.
Department of Surgery, Maasstad Hospital, Rotterdam, Netherlands.
Surg Obes Relat Dis. 2017 Apr;13(4):594-599. doi: 10.1016/j.soard.2016.11.023. Epub 2016 Dec 5.
Failed laparoscopic adjustable gastric banding (LAGB) can be converted to laparoscopic Roux-and-Y gastric bypass (LRYGB), which is currently the gold standard for bariatric surgery. Revisional LRYGB (rLRYGB) is associated with inferior results compared with primary LRYGB (pLRYGB), but the exact influence of the initial response to LAGB is unclear.
To compare follow-up outcomes after pLRYGB with rLRYGB in nonresponders of LAGB and rLRYGB in responders of LAGB.
General-community teaching hospital, Rotterdam, the Netherlands.
All patients who underwent pLRYGB and rLRYGB after LAGB were reviewed in an observational study. Postoperative outcomes, excess weight loss, total weight loss, and success and failure rate were compared in patients after pLRYGB and rLRYGB (both responders and nonresponders of LAGB) at 12, 24, and 36 months.
A total of 1285 primary patients, 96 nonresponders, and 120 responders were included. The median follow-up was 33.9±18.0 months. After 36 months, the mean percentage excess weight loss was significantly lower in the nonresponding group compared with the responding and primary groups (48.1% versus 58.2% versus 72.8%, P<.001); the total weight loss showed the same trend. The success rate was 38.2% versus 61.0% versus 81.6% respectively, P<.001. The failure rate was significantly higher after rLRYGB compared with pLRYGB (10.9% nonresponders, 8.5% responders, and 2.5% primary, P = .001).
Nonresponders of LAGB show inferior weight loss results after rLRYGB compared with responders of LAGB and pLRYGB at all moments of follow-up.
失败的腹腔镜可调节胃束带术（LAGB）可转换为腹腔镜Roux-en-Y胃旁路术（LRYGB），LRYGB目前是减肥手术的金标准。与初次LRYGB（pLRYGB）相比，翻修LRYGB（rLRYGB）的效果较差，但LAGB初始反应的确切影响尚不清楚。
比较LAGB无反应者接受pLRYGB与rLRYGB后的随访结果，以及LAGB有反应者接受rLRYGB后的随访结果。
荷兰鹿特丹的社区教学医院。
在一项观察性研究中，对所有在LAGB术后接受pLRYGB和rLRYGB的患者进行了回顾。比较了pLRYGB和rLRYGB术后患者（包括LAGB有反应者和无反应者）在12、24和36个月时的术后结果、超重减轻情况、总体体重减轻情况以及成功率和失败率。
共纳入1285例初次手术患者、96例无反应者和120例有反应者。中位随访时间为33.9±18.0个月。36个月后，无反应组的平均超重减轻百分比显著低于有反应组和初次手术组（48.1%对58.2%对72.8%，P<0.001）；总体体重减轻情况呈现相同趋势。成功率分别为38.2%、61.0%和81.6%，P<0.001。与pLRYGB相比，rLRYGB后的失败率显著更高（无反应者为10.9%，有反应者为8.5%，初次手术者为2.5%，P = 0.001）。
在所有随访时间点，LAGB无反应者接受rLRYGB后的体重减轻效果均低于LAGB有反应者和pLRYGB。
