Department of General Surgery, Fondazione Salus Clinica Di Lorenzo, Via Vittorio Veneto n 37, Avezzano, L'Aquila, Italy.
Department of Biomedical Science for Health, Division of General and Emergency Surgery, University of Milan, Milan, Milan, Italy.
Obes Surg. 2018 Sep;28(9):2626-2633. doi: 10.1007/s11695-018-3220-1.
The laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold standard treatment for morbid obesity. After LRYGB, the endoscopic access to the gastric remnant and pancreaticobiliary system is challenging. The laparoscopic gastric bypass with fundectomy and exploration of the gastric remnant (LRYGBfse) was introduced in an attempt to overcome this limitation. The purpose of this study was to analyze the medium-term outcomes and safety of LRYGBfse.
Observational prospective single-arm multicenter cohort study. Patients with BMI > 35 kg/m were included. Previous open abdominal surgery was an exclusion criterion. Postoperative 1, 2, 3, and 5-year weight loss, BMI decrease, and percentage of excess weight loss (%EWL) were recorded. Wilcoxon signed rank sum test was used for paired data.
Among 653 enrolled patients, 229 completed the 5-year follow-up. Preoperative median body weight (kg) and BMI (kg/m) were 133.4 kg (interquartile range (IQR) = 12.0) and 48.2 kg/m (IQR = 10.1), respectively. Median 5-year body weight, BMI, and %EWL were 83.7 (IQR = 17.3), 31.2 (IQR = 7.7), and 74.8 (IQR = 23.4), respectively, all significantly improved compared to baseline (p = 0.002, p = 0.001, and p = 0.012, respectively). Comorbid improvement or resolution was observed in 88% of the patients. No major intraoperative complications were reported. Postoperative overall morbidity and mortality rates were 1 and 0%, respectively. Banding removal was necessary in one patient 62 months after the index operation.
The LRYGBfse seems safe and effective with durable results at 5-year follow-up. Endoscopic exploration of the gastric remnant is an additional valuable tool.
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）是治疗病态肥胖的金标准。在 LRYGB 之后，内镜进入胃残端和胰胆系统具有挑战性。腹腔镜胃旁路联合胃切除术和胃残端探查（LRYGBfse）被引入，试图克服这一限制。本研究旨在分析 LRYGBfse 的中期结果和安全性。
观察性前瞻性单臂多中心队列研究。纳入 BMI>35kg/m²的患者。既往开腹手术为排除标准。记录术后 1、2、3 和 5 年的体重减轻、BMI 下降和多余体重减轻百分比（%EWL）。采用配对符号秩和检验进行配对数据比较。
在 653 名入组患者中，229 名完成了 5 年随访。术前中位数体重（kg）和 BMI（kg/m²）分别为 133.4kg（四分位距（IQR）=12.0）和 48.2kg/m²（IQR=10.1）。中位数 5 年体重、BMI 和 %EWL 分别为 83.7kg（IQR=17.3）、31.2kg/m²（IQR=7.7）和 74.8%EWL（IQR=23.4），与基线相比均显著改善（p=0.002、p=0.001 和 p=0.012）。88%的患者观察到合并症改善或缓解。无重大术中并发症报告。术后总发病率和死亡率分别为 1%和 0%。1 例患者在索引手术后 62 个月需要去除带。
LRYGBfse 在 5 年随访时似乎是安全有效的，结果持久。胃残端内镜检查是一种额外有价值的工具。
