Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Department of Obesity and Metabolic surgery, Helios Klinikum, Berlin, Germany.
Obes Surg. 2020 Mar;30(3):797-803. doi: 10.1007/s11695-019-04361-x.
After laparoscopic Roux-en-Y gastric bypass (RYGB), approximately 10-35% of patients with morbid obesity regain weight after an initial good result or fail to achieve a sufficient amount of weight loss. Patients in which conservative measures are not successful may potentially benefit from revisional surgery.
To evaluate the effect of a non-adjustable ring placed around the gastric pouch in patients with insufficient weight loss or weight regain after RYGB.
Four specialized bariatric hospitals in The Netherlands, Germany, and Switzerland.
From 2011 to 2017, 79 patients underwent revisional surgery using a non-adjustable silicone ring because of insufficient results after RYGB. Data on weight loss and complications up to 2 years after revisional surgery was collected and analyzed retrospectively.
A follow-up percentage of 86% after 1 year and 61% after 2 years was achieved. In 75% of patients, further weight regain was prevented. Percentage total body weight loss improved by 7 to 26% 1 year after revisional surgery and remained stable during 2 years of follow-up. The additional weight loss effect of placing a non-adjustable ring was more pronounced in patients with an initial good result after primary RYGB. Eighteen (23%) rings were removed, most often due to dysphagia.
Especially for patients who experience weight regain after initial good weight loss, placing a non-adjustable silicone ring around the gastric pouch results in modest improvements in weight loss. To prevent the risk of ring removal due to dysphagia, surgeons should take notice not to place the ring too tight around the gastric pouch during revisional surgery.
腹腔镜 Roux-en-Y 胃旁路（RYGB）术后，约 10-35%的病态肥胖患者在初始良好结果后体重会反弹，或未能达到足够的减重效果。对于保守治疗无效的患者，可能会从修正手术中受益。
评估在 RYGB 后体重减轻不足或体重反弹的患者中，使用环绕胃袋的不可调节环的效果。
荷兰、德国和瑞士的 4 家专门的减肥医院。
2011 年至 2017 年，79 例因 RYGB 后效果不佳而接受不可调节硅胶环修正手术的患者，收集并回顾性分析了修正手术后 2 年的减重和并发症数据。
术后 1 年的随访率为 86%，2 年的随访率为 61%。75%的患者进一步防止了体重反弹。术后 1 年，总体体重减轻百分比提高了 7%至 26%，2 年随访期间保持稳定。在原发性 RYGB 后初始减重效果良好的患者中，放置不可调节环的额外减重效果更为明显。18 个（23%）环被取出，最常见的原因是吞咽困难。
特别是对于初始减重效果良好但随后体重反弹的患者，在胃袋周围放置不可调节的硅胶环可适度改善减重效果。为了防止因吞咽困难而取出环的风险，外科医生在修正手术时应注意不要将环环绕胃袋放置得太紧。
