Boru Cristian Eugeniu, Greco Francesco, Giustacchini Piero, Raffaelli Marco, Silecchia Gianfranco
Department of Medico-Surgical Sciences and Biotechnologies, Division General Surgery and Bariatric Center of Excellence-IFSO, "Sapienza" University of Rome, ICOT Hospital, Via F. Faggiana, 1668, Latina, Italy.
Department of General Surgery, Andosilla Hospital, ASL VT, Civita Castellana, Italy.
Langenbecks Arch Surg. 2018 Jun;403(4):473-479. doi: 10.1007/s00423-018-1675-0. Epub 2018 Apr 20.
The outcomes of failed laparoscopic sleeve gastrectomies (LSG) converted to laparoscopic standard R-Y gastric bypass (LRYGB) in case of insufficient weight loss (IWL), weight regain (WR), and/or severe gastro-esophageal reflux disease (GERD) are scanty.
To evaluate incidence, indications, and short-term outcomes of LSG conversion to LRYGB in three bariatric centers.
Patients operated between January 2012 and December 2016 by primary LSG, with mean follow-up of 24 months and converted to LRYGB for IWL, WR, and/or GERD, were retrospectively analyzed for demographics, operative details, perioperative complications, comorbidities evolution, and further WL.
Thirty patients (2.76%, 7 M/23 F, mean age 41 ± 10.1 years, initial mean BMI 46.9 ± 6.3 kg/m) were successfully converted after a mean period of 33 ± 27.8 months for severe GERD (15 patients, 50%), GERD and IWL/WR (3 patients, 10%), and IWL/WR (12 patients, 40%). Surgical complications occurred in three patients (10%). Mean BMI at revision time was 36 ± 9 kg/m, and 30.8 ± 5.2, 28 ± 4.9, and 28 ± 4.3 kg/m after 6, 12, and 24 months, respectively. Resolution of GERD was achieved in 83% of cases. Overall, postoperative satisfaction was reported by 96% of the cases, after mean follow-up of 24 ± 8.9 months.
In high-volume centers, where strict criteria for patients' selection for LSG are applied, the expected incidence of reoperations for "non-responder" (IWL/WR) or de novo or persistent severe GERD non-responder to medical treatment is low (< 3%). Conversion of "non-responder" LSG to LRYGB is effective for further WL and GERD remission at short term (2 years follow-up); however, a high postoperative complication rate was observed. Long-term multidisciplinary follow-up is mandatory to confirm data on WL durability and comorbidity control.
对于因体重减轻不足（IWL）、体重反弹（WR）和/或严重胃食管反流病（GERD）而转为腹腔镜标准R-Y胃旁路术（LRYGB）的失败腹腔镜袖状胃切除术（LSG）的结果报道较少。
评估三个减肥中心从LSG转为LRYGB的发生率、适应证和短期结果。
回顾性分析2012年1月至2016年12月期间接受初次LSG手术、平均随访24个月、因IWL、WR和/或GERD转为LRYGB的患者的人口统计学资料、手术细节、围手术期并发症、合并症演变情况及进一步的体重减轻情况。
30例患者（2.76%，7例男性/23例女性，平均年龄41±10.1岁，初始平均BMI为46.9±6.3kg/m²）在平均33±27.8个月后因严重GERD（15例患者，50%）、GERD合并IWL/WR（3例患者，10%）和IWL/WR（12例患者，40%）成功转为LRYGB。3例患者（10%）发生手术并发症。再次手术时的平均BMI为36±9kg/m²，6个月、12个月和24个月后的平均BMI分别为30.8±5.2kg/m²、28±4.9kg/m²和28±4.3kg/m²。83%的病例GERD得到缓解。总体而言，在平均随访24±8.9个月后，96%的病例报告了术后满意度。
在应用严格的LSG患者选择标准的大容量中心，“无反应者”（IWL/WR）或新发或持续性严重GERD药物治疗无反应者再次手术的预期发生率较低（<3%）。将“无反应者”LSG转为LRYGB对短期内（2年随访）的进一步体重减轻和GERD缓解有效；然而，观察到较高的术后并发症发生率。必须进行长期多学科随访以确认体重减轻持久性和合并症控制的数据。
