Buchwald Henry, Oien Danette M
Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 195, Minneapolis, MN, 55455, USA.
Obes Surg. 2017 Sep;27(9):2293-2302. doi: 10.1007/s11695-017-2658-x.
The long-limb Roux-en-Y gastric bypass (LLRYGB) was introduced in 1987 as a salvage operation for inadequate weight loss after a standard Roux-en-Y gastric bypass (RYGB).
We report on 53 consecutive patients (44 females) with conversion of a failed RYGB to a LLRYGB performed by a single surgeon between 2002 and 2014. No patient had an ascertainable anatomic abnormality to explain his/her weight regain. LLRYGB revision consisted of a 75-cm to 100-cm alimentary Roux limb and a 75-cm to 100-cm common channel; after 2011, in suitable patients, the Roux limb was lengthened to greater than 250 cm.
Average values for weight (lbs) were as follows: pre-original RYGB = 329; lowest measured after RYGB = 196; at time of LLRYGB = 285; and at 1, 2, 3, 4, >5 years post LLRYGB = 225, 207, 199, 197, 195, for a sustained weight loss >90 lbs. Average values for BMI (kg/m) were as follows: pre-original RYGB = 54.3; lowest measured after RYGB = 32.3; at time of LLRYGB = 47.2; and at 1, 2, 3, 4, >5 years post LLRYGB = 37.1, 34.4, 33.0, 32.8, 31.4, for a sustained BMI reduction >16.5 kg/m. Zero operative mortality; 3 (5.7%) late deaths; 7 (13.2%) 30-day complications; 33 (62.3%) long-term complications with 23 (43.4%) needing TPN; and 14 (26.4%) requiring operative revision.
A salvage LLRYGB procedure can be performed safely and is weight successful, but fraught with long-term nutritional problems and a high necessity for revision. A Roux segment over 250 cm may improve outcomes.
长肢Roux-en-Y胃旁路术（LLRYGB）于1987年被引入，作为标准Roux-en-Y胃旁路术（RYGB）后减重不足的挽救手术。
我们报告了2002年至2014年间由同一位外科医生对53例连续患者（44例女性）进行的从失败的RYGB转换为LLRYGB的手术。没有患者有可确定的解剖学异常来解释其体重反弹。LLRYGB翻修包括一个75厘米至100厘米的消化道Roux袢和一个75厘米至100厘米的共同通道；2011年后，对于合适的患者，Roux袢延长至超过250厘米。
体重（磅）的平均值如下：初次RYGB术前 = 329；RYGB术后测得的最低体重 = 196；LLRYGB时 = 285；LLRYGB术后1、2、3、4、>5年 = 225、207、199、197、195，持续减重>90磅。体重指数（kg/m）的平均值如下：初次RYGB术前 = 54.3；RYGB术后测得的最低值 = 32.3；LLRYGB时 = 47.2；LLRYGB术后1、2、3、4、>5年 = 37.1、34.4、33.0、32.8、31.4，持续体重指数降低>16.5 kg/m。手术死亡率为零；3例（5.7%）晚期死亡；7例（13.2%）发生30天并发症；33例（62.3%）出现长期并发症，其中23例（43.4%）需要全胃肠外营养；14例（26.4%）需要手术翻修。
挽救性LLRYGB手术可以安全进行且减重成功，但充满长期营养问题且翻修必要性高。超过250厘米的Roux段可能改善手术效果。
