Filip Simona, Hutopila Ionut, Copaescu Catalin
Chirurgia (Bucur). 2019 Nov-Dec;114(6):809-823. doi: 10.21614/chirurgia.114.6.809.
Laparoscopic gastric sleeve is a well-known bariatric procedure with good results on weight loss and remission of comorbidities. For patients with weight regain and a large sleeved stomach, the laparoscopic re-sleeve (re-LSG) can be considered a revisional option.
The objective of this study is to evaluate the results of laparoscopic re-sleeve as revisional procedure in patients with weight regain after gastric sleeve, in a Center of Excellence in Bariatric Surgery (BS-CoE).
A retrospective evaluation of a prospectively maintained database identified 27 patients who underwent laparoscopic gastric re-sleeve after gastric sleeve from January 2013 - December 2016 in our BS-CoE. Patients were monitored in conformity with our standard bariatric program and the efficiency of re-sleeve in terms of weight loss and comorbidities outcome was evaluated at 6 months, 1 year and 3 years postoperative. Re-sleeve gastrectomy was performed by laparoscopic approach in all cases and 24 (89%) patients had concurrent surgical procedures, all of them hiatal hernia repair. No intra or postoperative complications were found except one case of gastric tube stenosis. Mean BMI before resleeve was 35.69 kg/m2 (range 28,58-52) and follow-up results at 6 months after re-sleeve revealed mean BMI was 28.39 +- 5.32 kg/m2 with EWL 83.88%, at 1 year mean BMI 27.23 +- 5.23 kg/m2 with EWL 94.45% and at 3 years BMI 27.65 +- 5.13 kg/m2 with EWL 85.41%. There are statistically significant differences (p 0.01), between BMI before re-sleeve and BMI for all other moments of measurement 6 months, 1 year and 3 years after re-sleeve. All the 6 patients (22%) with comorbidities before re-sleeve had remission of their diseases at ne year postoperative, but 1 patient had recurrence of hypertension at 3 years postoperative.
Laparoscopic redo sleeve is an efficient revisional surgery option for weight regain after primary gastric sleeve with effective weight loss and improvement of comorbidities in a medium term follow-up.
腹腔镜胃袖状切除术是一种著名的减肥手术，在减重和缓解合并症方面效果良好。对于体重反弹且胃袖状切除术后胃腔较大的患者，腹腔镜再次胃袖状切除术（re-LSG）可被视为一种修正手术选择。
本研究的目的是评估在一家减肥手术卓越中心（BS-CoE），腹腔镜再次胃袖状切除术作为胃袖状切除术后体重反弹患者的修正手术的效果。
对一个前瞻性维护的数据库进行回顾性评估，确定了2013年1月至2016年12月期间在我们的BS-CoE接受腹腔镜胃袖状切除术后再次胃袖状切除术的27例患者。患者按照我们的标准减肥方案进行监测，并在术后6个月、1年和3年评估再次胃袖状切除术在减重和合并症结局方面的效果。所有病例均通过腹腔镜方法进行再次胃袖状切除术，24例（89%）患者同时进行了其他手术，均为食管裂孔疝修补术。除1例胃管狭窄外，未发现术中或术后并发症。再次胃袖状切除术术前平均BMI为35.69kg/m²（范围28.58 - 52），再次胃袖状切除术后6个月的随访结果显示平均BMI为28.39±5.32kg/m²，超重百分比（EWL）为83.88%，1年时平均BMI为27.23±5.23kg/m²，EWL为94.45%，3年时BMI为27.65±5.13kg/m²，EWL为85.41%。再次胃袖状切除术术前BMI与术后6个月、1年和3年所有其他测量时刻的BMI之间存在统计学显著差异（p < 0.01）。再次胃袖状切除术术前有合并症的所有6例患者（22%）在术后1年疾病缓解，但1例患者在术后3年高血压复发。
腹腔镜再次胃袖状切除术是原发性胃袖状切除术后体重反弹的一种有效修正手术选择，在中期随访中能有效减重并改善合并症。
