Roux-en-Y 胃旁路术后体重不足或反弹的再次手术：胆胰支长度很重要。

Revisional Surgery for Insufficient Loss or Regain of Weight After Roux-en-Y Gastric Bypass: Biliopancreatic Limb Length Matters.

机构信息

Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.

Clarunis, University Center for Gastrointestinal and Liver Diseases, 4002, Basel, Switzerland.

出版信息

Obes Surg. 2020 Mar;30(3):804-811. doi: 10.1007/s11695-019-04348-8.

DOI:10.1007/s11695-019-04348-8

PMID:31863410

Abstract

INTRODUCTION

Weight regain after laparoscopic Roux-en-Y gastric bypass (RYGB) occurs in up to 35% of patients. Revisional surgery may be applied. Conversion from RYGB to a long biliopancreatic limb (BPL) RYGB is a potential option for revisional surgery and short-term results are promising.

METHODS

All patients who underwent conversion to long BPL RYGB due to weight loss failure, defined as excess weight loss (EWL) < 50% or body mass index (BMI) > 35 kg/m, were assessed. Proximal RYGB or very very long limb RYGB (VVLL RYGB) was modified by shortening of the total alimentary limb length (TALL) to create a long BPL.

RESULTS

A total of 28 patients received revisional surgery from either PRYGB (n = 22) or VVLL RYGB (n = 6). Mean age at operation was 45.3 ± 10.4 years, with 78% females. Mean prerevisional BMI was 41.7 ± 4.4 kg/m. Mean time to revision was 76.5 ± 38.5 months. Limb lengths were 150 cm (95% CI 133-156 cm) for RL and 100 cm (95% CI 97-113 cm) for CC, thus providing a total median alimentary limb length of 250 (95% CI 238-260 cm). Additional %EWL and TWL improved significantly in long-term. Five years postoperatively, all patients (n = 9) had an EWL% > 50%. Six patients (21.4%) required reoperation due to severe malnutrition during the postoperative course.

CONCLUSION

Conversion from RYGB to BPL RYGB leads to significant additional weight loss in the long term. However, the morbidity is relevant, especially severe protein malnutrition and the frequency of revisional surgery. Therefore, this type of surgery should not be done routinely.

摘要

简介

腹腔镜 Roux-en-Y 胃旁路术（RYGB）后体重反弹的发生率高达 35%。可能需要进行修正手术。将 RYGB 转换为长胆胰支（BPL）RYGB 是修正手术的一种潜在选择，短期结果有希望。

方法

所有因减肥失败而接受长 BPL RYGB 转换的患者（定义为 excess weight loss (EWL) < 50%或 body mass index (BMI) > 35 kg/m）都进行了评估。近端 RYGB 或非常长胆胰支 RYGB（VVLL RYGB）通过缩短总喂养支长度（TALL）来修改为长 BPL。

结果

共有 28 例患者因 PRYGB（n=22）或 VVLL RYGB（n=6）接受修正手术。手术时的平均年龄为 45.3±10.4 岁，女性占 78%。术前平均 BMI 为 41.7±4.4 kg/m。修正手术的平均时间为 76.5±38.5 个月。RL 为 150cm（95%CI 133-156cm），CC 为 100cm（95%CI 97-113cm），因此总喂养支长度中位数为 250cm（95%CI 238-260cm）。长期随访中额外的 EWL%和 TWL 显著改善。术后 5 年，所有患者（n=9）的 EWL%均>50%。6 例患者（21.4%）因术后严重营养不良需要再次手术。