Digestive surgery department, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
Digestive surgery department, university hospital of Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex, France.
J Visc Surg. 2021 Feb;158(1):38-50. doi: 10.1016/j.jviscsurg.2020.08.014. Epub 2020 Sep 18.
Bariatric revisional surgery represents an important new issue for obese patients because of the considerable rate of failure and complications following bariatric surgery. As the frequency of bariatric procedures increases, so too does the incidence of revisional surgery, which has become becoming increasingly important. The surgeon must know the indications and the results of the various revisional procedures in order to best guide the therapeutic decision. The current challenge is to correctly select the patients for revisional surgery and to choose the appropriate procedure in each case. Multidisciplinary management is essential to patient re-assessment and to prepare the patient for a re- intervention. The objective of this update, based on data from all the most recent studies concerning revisional surgery, is to guide the surgeon in the choice of the revisional procedure, depending on patient characteristics, co-morbidities, the previously performed procedure, the type of failure or complication observed, but also on the surgeon's own habits and the center's expertise. The collected results show that revisional surgery is difficult, with higher complication rates and weight-loss results that are often lower than those of first-intent surgery. For these reasons, patient selection must be rigorous and multidisciplinary and the management in expert centers of these difficult situations must be encouraged.
减重手术失败后的再次手术是肥胖患者面临的一个重要新问题，因为减重手术后的失败率和并发症相当高。随着减重手术数量的增加，再次手术的发生率也越来越高，这一问题变得越来越重要。外科医生必须了解各种再次手术的适应证和结果，以便能够更好地指导治疗决策。目前的挑战是正确选择需要再次手术的患者，并在每种情况下选择合适的手术。多学科管理对于患者的重新评估以及为再次干预做好准备至关重要。基于所有关于再次手术的最新研究数据，本更新旨在根据患者特征、合并症、先前进行的手术、观察到的失败或并发症类型、外科医生自身习惯和中心专业知识，指导外科医生选择再次手术的方法。收集到的结果表明，再次手术具有一定难度，其并发症发生率较高，减重效果往往低于初次手术。出于这些原因，必须严格选择患者，并进行多学科管理，鼓励在专家中心处理这些复杂情况。
