Department of Visceral Surgery, Clarunis University Center for Gastrointestinal and Liver Diseases Basel, 4002, Basel, Switzerland.
Department of General Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.
Obes Surg. 2021 Jan;31(1):170-178. doi: 10.1007/s11695-020-04868-8. Epub 2020 Jul 23.
Laparoscopic sleeve gastrectomy (SG) may be associated with long-term problems such as insufficient weight loss or weight regain, persistence or relapse of comorbidities, and gastroesophageal reflux disease (GERD). This study analyzes the outcome of patients that underwent conversion of SG to a gastric bypass procedure.
All patients that underwent conversion from SG to the following four different gastric bypass procedures were analyzed: short biliopancreatic limb (BPL) bypass types such as proximal Roux-en-Y gastric bypass (PRYGB) or type 2 distal Roux-en-Y gastric bypass (type 2 DRYGB) and long BPL types such as long BPL RYGB or one anastomosis gastric bypass (OAGB).
Between 2012 and 2016, 52 patients received the following revisional procedures after primary SG: proximal RYGB (n = 12, 23.1%), type 2 DRYGB (n = 8, 15.4%), long BPL RYGB (n = 20, 38.5%), and OAGB (n = 12, 23.1%). The long BPL type procedures (long BPL RYGB, OAGB) resulted in a significant long-term additional %EWL (33.8%; 33.2%) at 3 years. In the PRYGB, the effect lasted only for 2 years. In all patients with GERD and dysphagia as the dominant post-SG symptoms, the conversion to a bypass procedure resulted in the complete resolution of these.
In case of weight regain or insufficient weight loss after SG, revisional surgery with a long BPL should be considered. The OAGB provides effective additional weight loss, with low morbidity and malnutrition rates, respectively. Conversion to the malabsorptive long BPL RYGB with a total alimentary limb length below 400 cm should be avoided. Patients that suffer primarily from post-SG GERD or dysphagia should undergo conversion to PRYGB.
腹腔镜袖状胃切除术（SG）可能会导致长期问题，如体重减轻不足或体重反弹、并存疾病持续存在或复发，以及胃食管反流病（GERD）。本研究分析了接受 SG 转为胃旁路手术的患者的结果。
所有接受 SG 转为以下四种不同胃旁路手术的患者均进行了分析：短胆胰支（BPL）旁路类型，如近端 Roux-en-Y 胃旁路术（PRYGB）或 2 型远端 Roux-en-Y 胃旁路术（2 型 DRYGB）和长 BPL 类型，如长 BPL Roux-en-Y 胃旁路术或单吻合口胃旁路术（OAGB）。
2012 年至 2016 年间，52 例患者在初次 SG 后接受了以下修正手术：近端 Roux-en-Y 胃旁路术（n=12，23.1%）、2 型远端 Roux-en-Y 胃旁路术（n=8，15.4%）、长 BPL Roux-en-Y 胃旁路术（n=20，38.5%）和单吻合口胃旁路术（n=12，23.1%）。长 BPL 型手术（长 BPL Roux-en-Y 胃旁路术、OAGB）在 3 年后导致显著的长期额外体重减轻百分比（33.8%；33.2%）。在 PRYGB 中，效果仅持续 2 年。所有因 SG 后出现 GERD 和吞咽困难为主要症状的患者，转为旁路手术后这些症状完全缓解。
如果 SG 后体重反弹或体重减轻不足，应考虑进行修正手术。OAGB 可提供有效的额外减重效果，且发病率和营养不良率均较低。应避免将总肠袢长度低于 400cm 的吸收不良长 BPL Roux-en-Y 胃旁路术转为吸收不良的长 BPL Roux-en-Y 胃旁路术。主要因 SG 后 GERD 或吞咽困难而受影响的患者应转为 PRYGB。
