比较袖状胃切除术失败后的再次袖状胃切除术与 Roux-en-Y 胃旁路术。
Comparison of Repeat Sleeve Gastrectomy and Roux-en-Y Gastric Bypass in Case of Weight Loss Failure After Sleeve Gastrectomy.
机构信息
Department of Digestive, Esogastric and Bariatric Surgery, Bichat Claude Bernard University Hospital, 46 rue Henri Huchard, F-75018, Paris, France.
Department of Medical and Oral Sciences and Biotechnologies, "G.d'Annunzio" University, Via dei Vestini 31, 66100, Chieti, Italy.
出版信息
Obes Surg. 2019 Dec;29(12):3919-3927. doi: 10.1007/s11695-019-04123-9.
BACKGROUND
Few series are available on the results of repeat sleeve gastrectomy (re-SG) and Roux-en-Y gastric bypass (RYGB) performed to manage the failure of primary sleeve gastrectomy (SG). The objective of this study was to compare the short- and medium-term outcomes of re-SG and RYGB after SG.
MATERIAL & METHODS: Between January 2010 and December 2017, patients undergoing re-SG (n = 61) and RYGB (n = 83) for failure of primary SG were included in this study. Revisional surgery was proposed for patients with insufficient excess weight loss (EWL ≤ 50%) or weight regain. The primary endpoint was the comparison of weight loss in the re-SG group and the RYGB group at the 1-year follow-up. The secondary endpoints were overall mortality and morbidity, specific morbidity, length of stay, weight loss, and correction of comorbidities.
RESULTS
The mean interval between SG and re-SG was 41.5 vs. 43.2 months between SG and RYGB (p = 0.32). The mean operative time was 103 min (re-SG group) vs. 129.4 min (RYGB group). One death (1.7%; re-SG group) and 25 complications (17.4%; 9 in the re-SG group, 16 in the RYGB group) were observed. At the 1 year, mean body mass index was 31.6 in the re-SG group and 32.5 in the RYGB group (p = 0.61) and excess weight loss was 69.5 vs. 61.2, respectively (p = 0.05).
CONCLUSION
Re-SG and RYGB as revisional surgery for SG are feasible with acceptable outcomes and similar results on weight loss on the first postoperative year.
背景
针对原发性袖状胃切除术（SG）失败后行重复袖状胃切除术（re-SG）和 Roux-en-Y 胃旁路术（RYGB）的结果，仅有少数系列报道。本研究旨在比较 SG 后行 re-SG 和 RYGB 的短期和中期结果。
材料和方法
2010 年 1 月至 2017 年 12 月，纳入因原发性 SG 失败而行 re-SG（n=61）和 RYGB（n=83）的患者。对 EWL≤50%或体重反弹的患者建议行修正手术。主要终点是 re-SG 组和 RYGB 组在 1 年随访时的体重减轻情况比较。次要终点是总体死亡率和发病率、特定发病率、住院时间、体重减轻和合并症的纠正。
结果
SG 与 re-SG 之间的平均间隔为 41.5 个月，SG 与 RYGB 之间的平均间隔为 43.2 个月（p=0.32）。手术时间平均为 103 分钟（re-SG 组）和 129.4 分钟（RYGB 组）。re-SG 组发生 1 例死亡（1.7%）和 25 例并发症（17.4%，9 例在 re-SG 组，16 例在 RYGB 组）。1 年后，re-SG 组和 RYGB 组的平均体重指数分别为 31.6 和 32.5（p=0.61），超重减轻量分别为 69.5%和 61.2%（p=0.05）。
结论
SG 后行 re-SG 和 RYGB 作为修正手术是可行的，具有可接受的结果，术后第 1 年体重减轻的效果相似。
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