腹腔镜楔形切除胃空肠吻合口治疗胃旁路术后体重复增

Laparoscopic Wedge Resection of Gastrojejunostomy for Weight Recidivism after Gastric Bypass.

作者信息

Elbahrawy Aly, Bougie Alexandre, Albader Mohammad, Aggarwal Rajesh, Demyttenaere Sebastian, Andalib Amin, Court Olivier

机构信息

Department of Surgery, Division of General Surgery, Center for Bariatric Surgery, McGill University Health Center Montreal General Hospital, 1650 Cedar Avenue, Room: E16-152, Montreal, QC, H3G 1A4, Canada.

Department of Clinical and Experimental Surgery, Medical Research Institute, Alexandria University, Alexandria, Egypt.

出版信息

Obes Surg. 2017 Nov;27(11):2829-2835. doi: 10.1007/s11695-017-2706-6.

DOI:10.1007/s11695-017-2706-6

PMID:28470487

Abstract

BACKGROUND

Weight recidivism after Roux-en-Y gastric bypass (RYGB) is a common problem. Often, this weight loss failure or regain may be due to a wide gastrojejunostomy (GJ). We evaluated the feasibility and safety of a novel approach of laparoscopic wedge resection of gastrojejunostomy (LWGJ) for a wide stoma after RYGB associated with weight recidivism.

METHODS

This is a single-center retrospective study of a prospectively collected database. We analyzed outcomes of patients with weight recidivism after RYGB and a documented wide GJ (>2 cm) on imaging, who underwent LWGJ between 11/2013 and 05/2016.

RESULTS

Nine patients underwent LWGJ for dilated stomas. All patients were female with a mean ± SD age of 53 ± 7 years. Mean interval between RYGB and LWGJ was 9 ± 3 years. All cases were performed laparoscopically with no conversions. Mean operative time and hospital stay were 86 ± 9 min and 1.2 ± 0.4 days, respectively. The median(IQR) follow-up time was 14(12-18) months. During follow-up, there were no deaths, postoperative complications, or unplanned readmissions or reoperations. The mean and median(IQR) BMI before RYGB and LWGJ were 55.4 ± 8.1 kg/m and 56.1(47.9-61.7) and 43.4 ± 8.6 kg/m and 42.1(38.3-47.1), respectively. One year after LWGJ, mean and median(IQR) BMI significantly decreased to 34.9 ± 7.3 kg/m and 33.3(31.7-35.0) corresponding to a mean %EWL of 64.6 ± 19.9 (P < 0.05).

CONCLUSIONS

LWGJ is safe and can lead to further weight loss in patients experiencing weight recidivism after RYGB with a wide GJ (>2 cm). Long-term follow-up is needed to determine the efficacy and durability of LWGJ and compare its outcomes with other endoscopic/surgical approaches for weight recidivism after RYGB with a documented wide GJ.

摘要

背景

Roux-en-Y胃旁路术（RYGB）后体重复发是一个常见问题。通常，这种体重减轻失败或体重反弹可能是由于胃空肠吻合口（GJ）过宽所致。我们评估了一种新型的腹腔镜胃空肠吻合口楔形切除术（LWGJ）治疗RYGB术后因吻合口过宽导致体重复发的可行性和安全性。

方法

这是一项对前瞻性收集数据库进行的单中心回顾性研究。我们分析了RYGB术后体重复发且影像学检查记录有胃空肠吻合口过宽（>2 cm）的患者的结局，这些患者在2013年11月至2016年5月期间接受了LWGJ手术。

结果

9例患者因吻合口扩张接受了LWGJ手术。所有患者均为女性，平均年龄±标准差为53±7岁。RYGB与LWGJ之间的平均间隔时间为9±3年。所有病例均通过腹腔镜完成，无中转开腹。平均手术时间和住院时间分别为86±9分钟和1.2±0.4天。中位（IQR）随访时间为14（12 - 18）个月。随访期间，无死亡、术后并发症、计划外再次入院或再次手术。RYGB和LWGJ术前的平均及中位（IQR）BMI分别为55.4±8.1 kg/m²和56.1（47.9 - 61.7）以及43.4±8.6 kg/m²和42.1（38.3 - 47.1）。LWGJ术后1年，平均及中位（IQR）BMI显著降至34.9±7.3 kg/m²和33.3（31.7 - 35.0），对应的平均%EWL为64.6±19.9（P < 0.05）。