Department of Bariatric and Metabolic Surgery, Hamad General Hospital, Doha, Qatar.
Department of Surgery, Weill Cornell Medical College, Doha, Qatar.
Obes Surg. 2020 Dec;30(12):4715-4723. doi: 10.1007/s11695-020-04933-2. Epub 2020 Aug 26.
Many revisional procedures are available for unsuccessful laparoscopic sleeve gastrectomy (LSG) in patients with complications or weight recidivism. Single anastomosis duodeno-ileal bypass (SADI-S) and one anastomosis gastric bypass (OAGB-MGB) are two revisional procedures to address the problem of weight recidivism. We aimed to evaluate the efficacy and outcomes of the 2 revisional approaches (SADI-S vs. OAGB-MGB).
A retrospective analysis of prospectively collected database of patients who underwent SADI-S or OAGB-MGB as a revisional procedure for weight recidivism after primary LSG with a minimum 1-year follow-up. Weight loss, comorbidities, nutritional deficiencies, complications, and outcomes were compared in the 2 procedures.
Ninety-one patients were included in the study (42 SADI-S and 49 OAGB-MGB). There was a significant weight loss (total weight loss percentage, TWL%) at 1-year follow-up observed for SADI-S when compared to OAGB-MGB (23.7 ± 5.7 vs. 18.7 ± 8.5, p = 0.02). However, this difference was not statistically significant at 18 months (26.4 ± 7.3 vs. 21.2 ± 11.0, p = 0.25). Remission of comorbidities (diabetes mellitus and hypertension) was comparable. Although OAGB-MGB had higher complication rate than SADI-S, the difference was not statistically significant (p = 0.39). No mortality was reported in the study groups.
Both SADI-S and OAGB-MGB are effective and safe revisional procedures for weight regain after LSG. The short-term outcomes are comparable; however, SADI-S is associated with less upper gastrointestinal complications and could be a better option for patients suffering from GERD post-LSG. Moreover, the underlying bile reflux may get worse with OAGB-MGB. However, further prospective larger studies are needed.
对于出现并发症或体重反弹的腹腔镜袖状胃切除术（LSG）失败患者，有许多翻修手术可供选择。单吻合口十二指肠-空肠旁路术（SADI-S）和单吻合口胃旁路术（OAGB-MGB）是两种针对体重反弹问题的翻修手术。我们旨在评估这两种翻修方法（SADI-S 与 OAGB-MGB）的疗效和结果。
对因 LSG 后体重反弹而行 SADI-S 或 OAGB-MGB 作为翻修术的患者进行前瞻性数据库回顾性分析，这些患者均具有至少 1 年的随访资料。比较两种手术的减重效果、合并症、营养缺乏、并发症和结局。
研究共纳入 91 例患者（42 例行 SADI-S，49 例行 OAGB-MGB）。SADI-S 组患者在 1 年随访时体重减轻量明显大于 OAGB-MGB 组（总减重百分比，TWL%：23.7±5.7% vs. 18.7±8.5%，p=0.02）。然而，在 18 个月时，这种差异无统计学意义（26.4±7.3% vs. 21.2±11.0%，p=0.25）。合并症（糖尿病和高血压）的缓解情况相当。尽管 OAGB-MGB 的并发症发生率高于 SADI-S，但差异无统计学意义（p=0.39）。两组均无死亡病例。
SADI-S 和 OAGB-MGB 均是 LSG 后体重反弹的有效且安全的翻修手术。短期结果相当，但 SADI-S 与上消化道并发症较少相关，对于 LSG 后患有 GERD 的患者可能是更好的选择。此外，OAGB-MGB 可能会导致潜在的胆汁反流加重。但仍需要进一步开展前瞻性的大型研究。
