General Surgery Division, The Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel.
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Obes Surg. 2019 Jan;29(1):215-220. doi: 10.1007/s11695-018-3503-6.
It is not uncommon to encounter patients seeking a third, fourth, or even fifth bariatric procedure. With higher expected complication rates and questionable patient benefit, the indication for multiple revisions is still in doubt. To evaluate the perioperative and post-operative outcomes of patients undergoing gastric bypass after two previous bariatric surgeries or more.
We identified all patients that underwent gastric bypass following at least 2 previous bariatric surgeries. We looked at patient demographics, previous bariatric surgeries, pre-operative body mass index (BMI) and obesity-related co-morbidities, perioperative complications, length of stay (LOS), re-admissions and re-operations, percentage of excess weight loss, and resolution or improvement in comorbidities.
Forty-two patients met the inclusion criteria, the majority being females (31, 73.8%). Average age was 45.6 years (range 27-62), average weight and BMI was 116 kg (range 75-175 kg) and 41.1 kg/m (range 25.6-58.7 kg/m), respectively. Thirty-two patients had two previous bariatric surgeries (73.8%), and 10 patients had 3 former bariatric surgeries (23.8%), and for one patient, this was the fifth bariatric procedure (2.4%). Mean LOS was 10 days (range 2-56 days). Eight patients (19%) needed re-admission and 5 (11.9%) needed re-operation. At a median follow up of 48 months (range 7-99 months), the average BMI was 34.5 kg/m (range 23.7-55.1 kg/m) reflecting an excess BMI loss of 43.3%.
Gastric bypass as a third or more bariatric procedure is effective yet associated with high complication rates, re-admissions, and re-operations.
遇到寻求第三次、第四次甚至第五次减重手术的患者并不罕见。由于预期并发症发生率较高且患者获益存在疑问，多次手术的适应证仍存在争议。本研究旨在评估至少接受过两次减重手术的患者行胃旁路术的围手术期和术后结局。
我们确定了所有至少接受过两次减重手术且再次接受胃旁路术的患者。我们观察了患者的人口统计学特征、既往减重手术史、术前体重指数（BMI）和肥胖相关合并症、围手术期并发症、住院时间（LOS）、再入院和再次手术、超重减轻百分比以及合并症的缓解或改善情况。
42 名患者符合纳入标准，其中大多数为女性（31 例，73.8%）。平均年龄为 45.6 岁（范围 27-62 岁），平均体重和 BMI 分别为 116kg（范围 75-175kg）和 41.1kg/m²（范围 25.6-58.7kg/m²）。32 名患者接受过两次减重手术（73.8%），10 名患者接受过三次减重手术（23.8%），1 名患者接受过五次减重手术（2.4%）。平均 LOS 为 10 天（范围 2-56 天）。8 名患者（19%）需要再次入院，5 名患者（11.9%）需要再次手术。中位随访时间为 48 个月（范围 7-99 个月），平均 BMI 为 34.5kg/m²（范围 23.7-55.1kg/m²），反映了超重减轻 43.3%。
胃旁路术作为第三次或更多次减重手术是有效的，但与高并发症发生率、再入院和再次手术相关。
