Poghosyan Tigran, Caille Clementine, Moszkowicz David, Hanachi Mouna, Carette Claire, Bouillot Jean-Luc
Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Université Paris Saclay, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France.
Department of Digestive, Oncologic and Metabolic Surgery, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Université Paris Saclay, UFR des sciences de la santé Simone Veil, Montigny-le-Bretonneux, France.
Surg Obes Relat Dis. 2017 Jun;13(6):988-994. doi: 10.1016/j.soard.2016.12.003. Epub 2016 Dec 9.
Omega-loop gastric bypass (OLGB) may be associated with severe complications, including anastomotic leak, refractory ulcer or stenosis, undernutrition, and disabling digestive disorders (chronic diarrhea, steatorrhea, bile reflux, and vomiting). OLGB conversion to Roux-en-Y gastric bypass (RYGB) was suggested to treat these complications.
To evaluate the efficacy and risk of severe complications after OLGB conversion to RYGB.
University hospital.
Retrospective analysis between October 2011 and June 2016.
Seventeen patients underwent OLGB conversion to RYGB. Fourteen patients (82%) presented at least 1 disabling digestive disorder. Before conversion, 10 patients (58.8%) received nutritional support for undernutrition. There was no postoperative mortality. Seven patients (41.1%) developed major adverse events (<90 d). At conversion, the average weight, body mass index, and percent of excess weight loss for the population without undernutrition (n = 7) were 103.7±24 kg, 38.7±6.8 kg/m², and 37%±33%, respectively. These values were 85±18.3 kg, 30.6±4.7 kg/m², and 73.3%±21.5%, respectively, at 2 years. In patients with undernutrition (n = 10), the average weight, body mass index, and percent of excess weight loss were 52.2±16.5 kg, 18.7±5.9 kg/m², and 149.3%±46.5%, respectively, before nutritional support and 58.9±14.7 kg, 21.1±5.2 kg/m², and 132.7%±39.1%, respectively, at revisional surgery. At 2 years the values were 71±5.6 kg, 24.3±2.2 kg/m², and 104.6%±15.2%, respectively. The patients experienced significant improvements in hypoalbuminemia, anemia, and vitamin/trace element deficiencies. The disabling digestive disorders resolved in 85% of patients.
The conversion of OLGB to RYGB for severe complications allows for weight correction in patients with undernutrition, reduces disabling digestive disorders, and improves the nutritional status of patients. However, the conversion is associated with high morbidity.
Ω袢胃旁路术（OLGB）可能与严重并发症相关，包括吻合口漏、难治性溃疡或狭窄、营养不良以及致残性消化系统疾病（慢性腹泻、脂肪泻、胆汁反流和呕吐）。有人建议将OLGB转换为Roux-en-Y胃旁路术（RYGB）来治疗这些并发症。
评估OLGB转换为RYGB后严重并发症的疗效和风险。
大学医院。
对2011年10月至2016年6月期间进行回顾性分析。
17例患者接受了从OLGB到RYGB的转换手术。14例患者（82%）至少有一种致残性消化系统疾病。转换手术前，10例患者（58.8%）因营养不良接受营养支持。术后无死亡病例。7例患者（41.1%）发生了严重不良事件（<90天）。转换手术时，无营养不良患者（n = 7）的平均体重、体重指数和超重减轻百分比分别为103.7±24 kg、38.7±6.8 kg/m²和37%±33%。2年后，这些值分别为85±18.3 kg、30.6±4.7 kg/m²和73.3%±21.5%。在营养不良患者（n = 10）中，营养支持前的平均体重、体重指数和超重减轻百分比分别为52.2±16.5 kg、18.7±5.9 kg/m²和149.3%±46.5%，翻修手术时分别为58.9±14.7 kg、21.1±5.2 kg/m²和132.7%±39.1%。2年后，这些值分别为71±5.6 kg、24.3±2.2 kg/m²和104.6%±15.2%。患者的低蛋白血症、贫血以及维生素/微量元素缺乏情况有显著改善。85%的患者致残性消化系统疾病得到缓解。
将OLGB转换为RYGB以治疗严重并发症可使营养不良患者的体重得到纠正，减少致残性消化系统疾病，并改善患者的营养状况。然而，这种转换手术的发病率较高。
