Department of Bariatric Surgery, AZ Sint-Blasius, Dendermonde, Belgium.
Surg Endosc. 2019 Aug;33(8):2572-2582. doi: 10.1007/s00464-018-6552-y. Epub 2018 Oct 23.
There is a paucity on literature data related to conversion of Omega anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB).
This is a retrospective study. Records of all patients who underwent this conversion were analyzed. Additionally, patients were contacted to answer a questionnaire on their current clinical condition.
Twenty-eight patients underwent laparoscopic conversion between September 2007 and June 2016. Indications were peritonitis in 7 patients (leaks after OAGB in 5, perforated marginal ulcer (MU) and blow-out remnant with concomitant leak in one patient each), anastomotic bleeding in one, bile reflux in 6, recalcitrant MU in 4, afferent loop syndrome in 6, postprandial vomiting in 2 (related to anastomotic stenosis and perianastomotic diverticulum, one each), and malnutrition and hypoglycemia both in 1. Thirty-day mortality was zero, complication rate (Clavien-Dindo grade III or more) 5% ((N = 1/20), abscess) when conversion was elective and 50.0% ((N = 4/8), all persisting leaks) when conversion was urgent. All 4 leaks persisting after conversion were successfully treated by endoscopic stenting, despite stent migration in 2 patients. Follow-up was available in 92.9%, for a mean time of 64.5 ± 30.1 months. Successful symptom relief (Likert score 4 or more) was noted for bile reflux and postprandial vomiting. Additionally, malnutrition was corrected.
When indicated, conversion of OAGB to RYGB is a safe treatment strategy. In case conversion is performed for leak after OAGB, persisting subclinical leaks are frequent but can be efficiently addressed by endoscopic stenting.
关于 Omega 吻合胃旁路术（OAGB）转为 Roux-en-Y 胃旁路术（RYGB）的文献数据很少。
这是一项回顾性研究。分析了所有接受这种转换的患者的记录。此外，还联系了患者以回答有关其当前临床状况的问卷。
2007 年 9 月至 2016 年 6 月期间，有 28 例患者接受了腹腔镜转换。适应证为 7 例患者的腹膜炎（OAGB 后漏 5 例，穿孔边缘性溃疡（MU）和爆裂残余物伴漏 1 例），吻合口出血 1 例，胆汁反流 6 例，顽固性 MU 4 例，输入袢综合征 6 例，餐后呕吐 2 例（吻合口狭窄和吻合口旁憩室各 1 例），营养不良和低血糖各 1 例。30 天死亡率为 0，并发症发生率（Clavien-Dindo 分级 III 级或以上）为 5%（N=20），当转换为选择性时为脓肿）和 50.0%（N=8），所有持续漏均为紧急转换。所有 4 例转换后持续存在的漏均通过内镜支架成功治疗，尽管有 2 例支架移位。92.9%的患者获得随访，平均随访时间为 64.5±30.1 个月。胆汁反流和餐后呕吐症状缓解（Likert 评分 4 或更高）。此外，营养不良得到纠正。
当有指征时，将 OAGB 转换为 RYGB 是一种安全的治疗策略。如果转换是为了 OAGB 后漏而进行的，则持续存在的亚临床漏是常见的，但可以通过内镜支架有效地解决。
