Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic, Cleveland, Ohio.
Center for Obesity and Diabetes, Oswaldo Cruz German Hospital, Sao Paulo, Brazil.
Surg Obes Relat Dis. 2017 Aug;13(8):1412-1421. doi: 10.1016/j.soard.2017.04.019. Epub 2017 Apr 25.
Primary bariatric surgery has been proven to be effective in weight loss and improvement of weight-related metabolic co-morbidities. However, a small proportion of patients after bariatric surgery either have persistent hyperglycemia or relapse after initial remission of their metabolic disease. Revisional bariatric surgery has been evaluated extensively for weight recidivism and postoperative complications. However, there has not been any high-level evidence validating the utility of revisional bariatric surgery on recurrent metabolic diseases, especially diabetes. In this review of 30 studies, we aimed to summarize the evidence and determine whether revisional surgery can have a positive impact on metabolic diseases that were not reversed by initial bariatric intervention. Overall, 14-38% of patients had residual diabetes at the time of revisional surgery. Depending on the index surgery and subsequent reconstruction, revisions induced 20-80% additional excess weight loss, or further decrease of body mass index by 10-30%. Improvement of diabetes was seen in 65-100% of patients. Specifically, conversion to Roux-en-Y gastric bypass (RYGB) yielded improvement of diabetes in 79%, 72%, and 62% of patients who previously had vertical banded gastroplasty (VBG), adjustable gastric banding (AGB), or sleeve gastrectomy (SG), respectively. Converting AGB to SG improved diabetes in 65% of patients, and SG to duodenal switch improved diabetes in 79% of patients. Revision of the gastric pouch or stoma in RYGB yielded improvement of diabetes in 79% of patients. Further clinical and mechanistic research is needed to better delineate the role of revisional bariatric surgery in patients with residual metabolic disease.
主要的减重手术已被证明在减轻体重和改善与体重相关的代谢合并症方面是有效的。然而，一小部分减重手术后的患者仍然存在高血糖，或者在代谢疾病最初缓解后复发。减重手术的修正术已广泛评估了体重反弹和术后并发症。然而，还没有任何高级别的证据证实修正性减重手术对复发性代谢疾病（特别是糖尿病）的实用性。在对 30 项研究的综述中，我们旨在总结证据，并确定修正手术是否对最初减重干预未能逆转的代谢疾病有积极影响。总体而言，有 14-38%的患者在进行修正手术时仍患有糖尿病。根据索引手术和后续重建，修正手术可使体重额外减轻 20-80%，或使体重指数进一步降低 10-30%。65-100%的患者糖尿病得到改善。具体来说，将垂直带胃成形术（VBG）改为 Roux-en-Y 胃旁路术（RYGB）后，分别有 79%、72%和 62%的先前接受过可调胃束带术（AGB）或袖状胃切除术（SG）的患者糖尿病得到改善。将 AGB 改为 SG 可使 65%的患者糖尿病得到改善，而将 SG 改为十二指肠转流术可使 79%的患者糖尿病得到改善。RYGB 中修正胃袋或吻合口可使 79%的患者糖尿病得到改善。需要进一步的临床和机制研究，以更好地阐明修正性减重手术在残余代谢疾病患者中的作用。
