Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria.
Obes Surg. 2019 Mar;29(3):943-948. doi: 10.1007/s11695-018-3614-0.
Revisional laparoscopic Roux-en-Y gastric bypass (R-LRYGB) is the preferred procedure after failed adjustable gastric banding. Little is known about whether a one-stage procedure (one surgery for band removal and R-LRYGB) or a two-stage procedure (first band removal and later R-LRYGB) is superior. Aim of this study is to compare early- and long-term results of both methods at our institution.
Retrospective analysis of 165 (m 26/f 139) consecutive patients (98 one-stage, 67 two-stage) with R-LRYGB. Mean follow-up time was 50.1 ± 38.8 months. Indications for one-stage vs. two-stage procedures, operating time, peri- and postoperative complications, morbidity, mortality, and length of stay (LOS) were analyzed. Data are reported as total numbers (%) and mean ± standard deviation.
Mean age at R-LRYGB was 43.9 ± 10.7 vs. 44.3 ± 10.7 years with a BMI of 37.1 ± 6.8 vs. 39.8 ± 7.1 (one-stage vs. two-stage). In the one-stage group, the main indication for revisional surgery was weight regain (57.1%), followed by dilatation of the esophagus or pouch (37.7%) and gastroesophageal reflux disease (GERD) (36.7%), whereas in the two-stage group, it was band erosion (52.2%) and dilatation of the esophagus or pouch (17.9%) and GERD (11.9%). There was no significant difference in operative time (208.5 ± 61.2 vs. 206.3 ± 73.5 min), LOS (8.6 ± 3.4 vs. 9.3 ± 5.7 days) or mortality (0% overall). Major complications (Clavien-Dindo ≥ IIIa) occurred similarly often in both groups: 15.3% vs. 16.9% (one-stage vs. two-stage).
Both approaches achieve good results. However, the one-stage R-LRYGB is the preferable procedure because it reduces costs and LOS by doing without an additional surgical procedure.
腹腔镜可调节胃束带松解术（LAGB）后复发的患者，首选的手术方式为再次腹腔镜 Roux-en-Y 胃旁路术（R-LRYGB）。目前对于行一次手术（同时行胃束带松解和 R-LRYGB）还是分次手术（先行胃束带松解，之后再行 R-LRYGB），哪种方式更优尚存争议。本研究旨在比较两种术式在我院的早期和长期结果。
回顾性分析了 165 例（男 26 例，女 139 例）行 R-LRYGB 的患者，其中 98 例行一次手术，67 例行两次手术。平均随访时间为 50.1±38.8 个月。分析了两种术式的适应证、手术时间、围手术期并发症、发病率、死亡率和住院时间（LOS）。数据以总数（%）和均值±标准差表示。
R-LRYGB 时的平均年龄为 43.9±10.7 岁 vs. 44.3±10.7 岁，BMI 为 37.1±6.8 千克/平方米 vs. 39.8±7.1 千克/平方米（一次手术组 vs. 两次手术组）。一次手术组的主要手术指征为体重反弹（57.1%），其次为食管或胃囊扩张（37.7%）和胃食管反流病（GERD）（36.7%），而两次手术组的主要手术指征为胃束带侵蚀（52.2%）、食管或胃囊扩张（17.9%）和 GERD（11.9%）。手术时间（208.5±61.2 分钟 vs. 206.3±73.5 分钟）、住院时间（8.6±3.4 天 vs. 9.3±5.7 天）或死亡率（均为 0%）无显著差异。两组的主要并发症（Clavien-Dindo≥IIIa 级）发生率相似：15.3% vs. 16.9%（一次手术组 vs. 两次手术组）。
两种方法均能取得良好的效果。然而，由于一次手术可避免再次手术，因此可降低成本和 LOS，所以 R-LRYGB 一次手术是首选的方法。
