Department of General Surgery, NYU Langone Medical Center, New York, New York.
Department of General Surgery, NYU Langone Medical Center, New York, New York.
Surg Obes Relat Dis. 2018 Oct;14(10):1531-1536. doi: 10.1016/j.soard.2018.06.002. Epub 2018 Jun 10.
Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) are often used as revisional surgeries for a failed laparoscopic adjustable gastric band (LAGB). There is debate over which procedure provides better long-term weight loss.
To compare the weight loss results of these 2 surgeries.
University hospital, United States.
A retrospective review was conducted of all LAGB to RYGB and LAGB to LSG surgeries performed at a single institution. Primary outcomes were change in body mass index (BMI), percent excess BMI lost, and percent weight loss. Secondary outcomes included 30-day complications and reoperations.
The cohort included 192 conversions from LAGB to RYGB and 283 LAGB to LSG. The baseline age and BMI were similar in the 2 groups. Statistical comparisons made between the 2 groups at 24 months postconversion were significant for BMI (RYGB = 32.93, LSG = 38.34, P = .0004), percent excess BMI lost (RYGB = 57.8%, LSG = 29.3%, P < .0001), and percent weight loss (RYGB = 23.4%, LSG = 12.6%, P < .0001). However, the conversion to RYGB group had a higher rate of reoperation (7.3% versus 1.4%, P = .0022), longer operating room time (RYGB = 120.1 min versus LSG = 115.5 min, P < .0001), and longer length of stay (RYGB = 3.33 d versus LSG = 2.11 d, P < .0001) than the LAGB to LSG group. Although not significant, the conversion to RYGB group had a higher rate of readmission (7.3% versus 3.5%, P = .087).
Weight loss is significantly greater for patients undergoing LAGB conversion to RYGB than LAGB to LSG. However, those undergoing LAGB conversion to RYGB had higher rates of reoperation and readmission. Patients looking for the most effective weight loss surgery after failed LAGB should be advised to have RYGB performed, while also understanding the increased risks of the procedure.
胃旁路术（RYGB）和腹腔镜袖状胃切除术（LSG）常用于腹腔镜可调节胃束带术（LAGB）失败后的修正手术。对于哪种手术能提供更好的长期减重效果，目前存在争议。
比较这两种手术的减重效果。
美国的一家大学医院。
对单一机构进行的 LAGB 转为 RYGB 和 LAGB 转为 LSG 手术进行回顾性分析。主要结果为体重指数（BMI）变化、多余 BMI 百分比减轻和体重百分比减轻。次要结果包括 30 天并发症和再次手术。
该队列包括 192 例 LAGB 转为 RYGB 和 283 例 LAGB 转为 LSG。两组的基线年龄和 BMI 相似。在术后 24 个月的两组间统计比较中，BMI（RYGB=32.93，LSG=38.34，P=.0004）、多余 BMI 百分比减轻（RYGB=57.8%，LSG=29.3%，P<.0001）和体重百分比减轻（RYGB=23.4%，LSG=12.6%，P<.0001）均有统计学意义。然而，转为 RYGB 组的再手术率（7.3%比 1.4%，P=.0022）更高，手术时间更长（RYGB=120.1 分钟，LSG=115.5 分钟，P<.0001），住院时间更长（RYGB=3.33 天，LSG=2.11 天，P<.0001）。虽然没有统计学意义，但转为 RYGB 组的再入院率（7.3%比 3.5%，P=.087）更高。
LAGB 转为 RYGB 患者的减重效果明显大于 LAGB 转为 LSG 患者。然而，转为 RYGB 的患者再手术和再入院率更高。对于寻求 LAGB 失败后最有效的减重手术的患者，应建议其进行 RYGB，但同时也要了解该手术的风险增加。
