Gastrointestinal surgical center (GISC), Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Ann Surg. 2021 Aug 1;274(2):271-280. doi: 10.1097/SLA.0000000000004485.
Comprehensive classification and evaluation of the outcome of limb distalization (LD) for inadequate weight loss after roux-en-y gastric bypass (RYGB).
Limb distalization is a revisional malabsorptive procedure for the management of inadequate weight loss after RYGB. Multiple studies with small sample sizes reported the outcome of LD. This meta-analysis aims to reach a higher level of evidence regarding the safety and efficacy of the procedure.
A systematic search, including all studies on LD for management of inadequate weight loss after RYGB. The search engines included were PubMed, Embase, Web of Science, Cochrane Library, Scopus, and EBSCOhost.
Fourteen studies were included. The pooled estimates of the mid-term percentage of excess weight loss (%EWL), diabetic, and hypertension remission were 50.8%, 69.9%, and 59.8%, respectively. The rate of surgical revision for the management of protein-energy malnutrition (PEM) was 17.1%. The %EWL was significantly higher with older age and good response to index surgery (P = 0.01, 0.04, respectively). Less total alimentary limb length was not associated with better %EWL (P = 0.9), but it was significantly associated with severe PEM (P = 0.01).
LD has an encouraging rate of resolution of comorbidities. A judicious patient selection is essential for better weight loss after LD. Type I LD with total alimentary limb length ≥350 cm was associated with less risk of malnutrition. PEM is a life-threatening complication that may require revisional surgery years after LD. Future studies on LD, adopting standardized surgical practice and terminology, will allow a more conclusive assessment of the outcome of the procedure.
综合分类和评估 Roux-en-Y 胃旁路术（RYGB）后体重减轻不足时的肢体远侧化（LD）的结局。
肢体远侧化是一种针对 RYGB 后体重减轻不足的修正性吸收不良手术。多项研究报告了 LD 的结果，但样本量较小。本荟萃分析旨在针对该手术的安全性和有效性获得更高水平的证据。
系统检索所有关于 LD 治疗 RYGB 后体重减轻不足的研究。使用的搜索引擎包括 PubMed、Embase、Web of Science、Cochrane 图书馆、Scopus 和 EBSCOhost。
共纳入 14 项研究。中期体重减轻多余百分比（%EWL）、糖尿病和高血压缓解的汇总估计值分别为 50.8%、69.9%和 59.8%。用于管理蛋白质能量营养不良（PEM）的手术修正率为 17.1%。%EWL 与年龄较大和对索引手术反应良好呈正相关（P = 0.01，0.04）。总肠段长度较短与更好的%EWL 无关（P = 0.9），但与严重 PEM 显著相关（P = 0.01）。
LD 对合并症的缓解率令人鼓舞。明智的患者选择对于 LD 后更好的体重减轻至关重要。总肠段长度≥350cm 的 I 型 LD 与营养不良风险降低相关。PEM 是一种危及生命的并发症，可能需要在 LD 多年后进行修正手术。未来采用标准化手术实践和术语的 LD 研究将允许对该手术的结果进行更具结论性的评估。
