Division of General Surgery, Department of Surgery, Vienna Medical University, Vienna, Austria.
Division of General Radiology, Department of Radiology and Nuclear Medicine, Vienna Medical University, Vienna, Austria.
Surg Obes Relat Dis. 2019 Oct;15(10):1719-1728. doi: 10.1016/j.soard.2019.07.002. Epub 2019 Jul 9.
Roux-en-Y gastric bypass (RYGB) is a well-established surgical method for morbid obesity; however, weight regain (WR) after initially good results may be considered an issue, the treatment of which has found no consensus yet.
The aim of this study was to compare the different surgical methods treating WR after RYGB that are used at the Vienna Medical University in a larger number of patients, concerning further weight loss, complications, and reoperations.
University hospital, Austria.
This study includes all patients with RYGB who were reoperated due to WR at the Vienna Medical University by December 2016 (n = 84). The follow-up rate was 93%. The following 4 approaches to treating WR after RYGB were taken: (1) pouch resizing, (2) pouch banding, (3) pouch resizing plus pouch banding, and (4) common limb shortening (i.e., distalization).
The mean maximum excess weight loss referring to the WR procedure in the 4 groups was as follows: group 1: 69.0% ± 35.2%, group 2: 62.8% ± 39.5%, group 3: 83.1% ± 30.9%, and group 4: 81.5% ± 41.6%. Reoperations occurred in the following different groups: group 1 had 2 balloon dilations (20%), groups 2 (n = 13) and 3 (n = 29) had 5 (38% and 17%) band removals each, and group 4 had 9 reversal procedures due to malnutrition (30%).
There are nonsignificant differences in terms of additional weight loss between the different methods. However, differences lay in the areas of adverse symptoms and further reoperations. While there was no risk of malnutrition with pouch resizing, there was with distalization. Pouch banding (with or without resizing) poses a higher risk of dysphagia.
Roux-en-Y 胃旁路术（RYGB）是治疗病态肥胖的一种成熟的手术方法；然而，最初结果良好后出现的体重反弹（WR）可能被认为是一个问题，但其治疗方法尚未达成共识。
本研究旨在比较维也纳医科大学治疗 RYGB 后 WR 的不同手术方法，这些方法在更多的患者中使用，涉及进一步的体重减轻、并发症和再次手术。
奥地利大学医院。
本研究包括 2016 年 12 月前因 WR 在维也纳医科大学接受再次手术的所有 RYGB 患者（n=84）。随访率为 93%。对 RYGB 后 WR 采取以下 4 种方法进行治疗：（1）胃袋缩小，（2）胃袋缩窄带，（3）胃袋缩小加胃袋缩窄带，和（4）共同肢体缩短（即远移）。
4 组 WR 手术的平均最大超重损失率如下：组 1：69.0%±35.2%，组 2：62.8%±39.5%，组 3：83.1%±30.9%，组 4：81.5%±41.6%。不同组发生了不同的再手术：组 1有 2 次球囊扩张（20%），组 2（n=13）和 3（n=29）各有 5 次缩窄带去除（38%和 17%），组 4有 9 次因营养不良（30%）而进行的逆转手术。
不同方法之间在额外体重减轻方面没有显著差异。然而，差异在于不良反应症状和进一步的再手术方面。胃袋缩小没有营养不良的风险，而远移则有。胃袋缩窄带（带或不带胃袋缩小）有更高的吞咽困难风险。
