Frantzides Constantine T, Alexander Brad, Frantzides Alexander T
Chicago Institute of Minimally Invasive Surgery, Skokie, Illinois, USA.
Presence St. Francis Hospital, Evanston, Illinois, USA.
JSLS. 2019 Jan-Mar;23(1). doi: 10.4293/JSLS.2018.00074.
The main indications for revision of bariatric surgery are inadequate weight loss, weight regain, or complications. The objective of revision is to restore the restrictive component and/or add a malabsorptive component.
To evaluate the effectiveness of revisional laparoscopic bariatric surgery for loss of weight and assess the risks and benefits associated with these technically demanding procedures.
Revision cases performed between 2001 and 2013 were identified and grouped according to the primary procedure and type of revision. A retrospective analysis was carried out for weight loss as well as perioperative morbidity and mortality.
The total of 271 patients underwent revisional laparoscopic surgery during the study period and were categorized into four groups. Group 1 (n = 67) had an adjustable gastric band converted to gastric bypass (GBP). Group 2 (n = 128) had a dilated gastric pouch after GBP and underwent pouch reduction. Group 3 (n = 57) had a GBP and underwent pouch reduction and elongation of the biliopancreatic limb. Group 4 (n = 19) had a vertical banded gastroplasty converted to a GBP. The mean total body weight loss for Groups 1 to 4 was 35.3%, 22.9%, 39.4%, and 33.2%, respectively. The average operative times were 185, 75, 142, and 205 minutes; and the average hospitalization was 1.5, 1.0, 2.0, and 2.5 days, respectively. All cases were completed laparoscopically. Concomitant procedures were liver biopsy, cholecystectomy, partial gastrectomy, hiatal, ventral, and internal hernia repairs. Complication rates were 2.9%, 0%, 3.5%, and 5.2% for each of the groups and there were no mortalities.
Results of revisional bariatric surgery vary depending on the original procedure and the reasons for revision. In particular, if the main reason for reoperation is inadequate weight loss, then the burden is to demonstrate a surgically correctable deficiency. Revisional procedures incorporating malabsorption result in greater weight loss than gastric restriction alone.
减肥手术翻修的主要指征是体重减轻不足、体重反弹或出现并发症。翻修的目的是恢复限制成分和/或增加吸收不良成分。
评估腹腔镜减肥翻修手术的减肥效果，并评估这些技术要求较高的手术的风险和益处。
确定2001年至2013年间进行的翻修病例，并根据初次手术和翻修类型进行分组。对体重减轻情况以及围手术期发病率和死亡率进行回顾性分析。
在研究期间，共有271例患者接受了腹腔镜翻修手术，并分为四组。第1组（n = 67）将可调节胃束带转换为胃旁路手术（GBP）。第2组（n = 128）在GBP术后出现胃囊扩张，并接受了胃囊缩小术。第3组（n = 57）接受了GBP手术，并进行了胃囊缩小术和胆胰支延长术。第4组（n = 19）将垂直带状胃成形术转换为GBP。第1组至第4组的平均总体重减轻分别为35.3%、22.9%、39.4%和33.2%。平均手术时间分别为185、75、142和205分钟；平均住院时间分别为1.5、1.0、2.0和2.5天。所有病例均通过腹腔镜完成。同期进行的手术包括肝活检、胆囊切除术、部分胃切除术、食管裂孔疝、腹壁疝和内疝修补术。各组的并发症发生率分别为2.9%、0%、3.5%和5.2%，无死亡病例。
减肥翻修手术的结果因初次手术和翻修原因而异。特别是，如果再次手术的主要原因是体重减轻不足，那么责任在于证明存在手术可纠正的缺陷。结合吸收不良的翻修手术比单纯的胃限制手术能带来更大程度的体重减轻。
