Bariatric Center of Excellence, Department of surgery, Texas Tech University Health Science Center, Lubbock, TX, USA.
Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warszawa, Poland.
Obes Surg. 2021 Feb;31(2):588-596. doi: 10.1007/s11695-020-04975-6. Epub 2020 Sep 18.
Reoperation, after failed gastric banding, is a controversial topic. A common approach is band removal with conversion to laparoscopic Roux-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) in a single-step procedure.
This study aimed to assess the safety of revisional surgery to LSG compared to LRYGB after failed laparoscopic adjustable gastric banding (LAGB) based on MBSAQIP Participant User File from 2015 to 2018.
Patients who underwent a one-stage conversion of LAGB to LSG (Conv-LSG) or LRYGB (Conv-LRYGB) were identified in the MBSAQIP PUF from 2015 to 2017. Conv-LRYGB cases were matched (1:1) with Conv-LSG patients using propensity scoring to control for potential confounding. The primary outcome was all-cause mortality.
A total of 9974 patients (4987 matched pairs) were included in the study. Conv-LRYGB, as compared with conv-SG, was associated with a similar risk of mortality (0.02% vs. 0.06%; relative risk [RR], 0.33; 95% confidence interval [CI], 0.03 to 3.20, p = 0.32). Conversion to LRYGB increased the risk for readmission (6.16% vs. 3.77%; RR, 1.63; 95%CI, 1.37 to 1.94, p < 0.01); reoperation (2.15% vs. 1.36%; RR, 1.57; 95%CI, 1.17 to 2.12, p = <0.01); leak (1.76% vs. 1.02%; RR, 1.57; 95%CI, 1.72 to 2.42, p < 0.01); and bleeding (1.66% vs. 1.00%; RR, 1.66; 95%CI, 1.7 to 2.34, p < 0.01).
The study shows that single-stage LRYGB and LSG as revisional surgery after gastric banding, are safe in the 30-day observation with an acceptable complication rate and low mortality. However, conversion to LRYGB increased the risk of perioperative complications.
胃束带减肥术失败后的再次手术是一个备受争议的话题。一种常见的方法是在一次手术中切除束带，将其转换为腹腔镜 Roux-Y 胃旁路术（LRYGB）或腹腔镜袖状胃切除术（LSG）。
本研究旨在根据 2015 年至 2018 年 MBSAQIP 参与者用户文件，评估胃束带减肥术失败后，将其转换为 LSG 与 LRYGB 进行再次手术的安全性。
在 2015 年至 2017 年 MBSAQIP PUF 中，确定了将胃束带一次转换为 LSG（Conv-LSG）或 LRYGB（Conv-LRYGB）的患者。使用倾向评分对 Conv-LRYGB 病例进行 1:1 匹配，以控制潜在的混杂因素。主要结局为全因死亡率。
共纳入 9974 例患者（4987 对匹配）。与 Conv-LSG 相比，Conv-LRYGB 的死亡率相似（0.02%比 0.06%；相对风险 [RR]，0.33；95%置信区间 [CI]，0.03 至 3.20，p=0.32）。转换为 LRYGB 增加了再入院（6.16%比 3.77%；RR，1.63；95%CI，1.37 至 1.94，p<0.01）、再次手术（2.15%比 1.36%；RR，1.57；95%CI，1.17 至 2.12，p=0.003）、漏（1.76%比 1.02%；RR，1.57；95%CI，1.72 至 2.42，p<0.01）和出血（1.66%比 1.00%；RR，1.66；95%CI，1.7 至 2.34，p<0.01）的风险。
本研究表明，胃束带减肥术失败后的单阶段 LRYGB 和 LSG 再次手术在 30 天观察期内是安全的，并发症发生率可接受，死亡率低。然而，转换为 LRYGB 会增加围手术期并发症的风险。
