Watson Michael D, Hunter Mehaffey J, Schirmer Bruce D, Hallowell Peter T
Department of Surgery, University of Virginia, Box 800709, Charlottesville, VA, 22903, USA.
Obes Surg. 2017 Sep;27(9):2398-2403. doi: 10.1007/s11695-017-2643-4.
Roux-en-Y gastric bypass (RYGB) effectively treats obesity and gastroesophageal reflux disease (GERD). As more surgeons recommend RYGB to treat GERD in patients with obesity, there are concerns about this approach in patients with previous non-bariatric foregut surgery. This study aims to evaluate the effect of previous non-bariatric foregut surgery on subsequent RYGB.
Retrospective review of 2089 patients undergoing RYGB between January 1985 and June 2015 was conducted to identify all patients with previous non-bariatric foregut surgery. Perioperative and postoperative data was collected by retrospective chart review.
A total of 11 patients with prior non-bariatric foregut surgery underwent RYGB with median time between operations of 95.6 months. Of note, 7/11 (63.6%) had previous Nissen fundoplication. Conversion to open operation was required in 3/7 (42.9%) with previous Nissen compared to 1/4 (25%) in those without previous Nissen. The average length of stay (LOS) was 3.9 ± 0.9 days, significantly longer than our institutional average for RYGB of 3.2 ± 3.2 days (p = 0.02). Mean percentage of excess body mass index loss (%EBMIL) was 64.7 ± 23.5 at 4-year median follow-up, comparable to our institution's previously reported data. No mortalities were attributed to RYGB and the overall complication rate was 18.2%, compared to our institutional complication rate for RYGB of 8.5% (p = 0.253).
Despite increased technical difficulty and increase perioperative morbidity, patients undergoing RYGB with previous non-bariatric foregut surgery had long-term symptom resolution and robust weight loss. This indicates that in the right hands, RYGB after non-bariatric foregut surgery may be performed safely and effectively.
Roux-en-Y胃旁路术（RYGB）能有效治疗肥胖症和胃食管反流病（GERD）。随着越来越多的外科医生推荐RYGB用于治疗肥胖症患者的GERD，对于曾接受过非减重前肠手术的患者采用这种方法存在担忧。本研究旨在评估既往非减重前肠手术对后续RYGB的影响。
对1985年1月至2015年6月期间接受RYGB的2089例患者进行回顾性分析，以确定所有曾接受过非减重前肠手术的患者。通过回顾病历收集围手术期和术后数据。
共有11例曾接受非减重前肠手术的患者接受了RYGB，两次手术之间的中位时间为95.6个月。值得注意的是，11例中有7例（63.6%）曾接受过nissen胃底折叠术。与未接受过nissen胃底折叠术的患者中1/4（25%）相比，接受过nissen胃底折叠术的患者中有3/7（42.9%）需要转为开放手术。平均住院时间（LOS）为3.9±0.9天，显著长于我们机构RYGB的平均住院时间3.2±3.2天（p = 0.02）。在中位随访4年时，平均超重体重指数丢失百分比（%EBMIL）为64.7±23.5，与我们机构之前报告的数据相当。没有死亡病例归因于RYGB，总体并发症发生率为18.2%，而我们机构RYGB的并发症发生率为8.5%（p = 0.253）。
尽管技术难度增加且围手术期发病率升高，但接受过非减重前肠手术的患者接受RYGB后症状得到长期缓解且体重显著减轻。这表明在经验丰富的医生手中，非减重前肠手术后的RYGB可以安全有效地进行。
