Kermansaravi Mohammad, Abbas Aamir, Pishgahroudsari Mohadeseh, Pazouki Abdolreza
Minimally Invasive Surgery Research Center, Iran University of Medical Sciences; Center of Excellence of International Federation for Surgery of Obesity and Metabolic Disorders, Tehran, Iran.
Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
J Minim Access Surg. 2021 Jul-Sep;17(3):318-321. doi: 10.4103/jmas.JMAS_27_20.
Revising the size of the gastric pouch during the conversion of one anastomosis gastric bypass (OAGB)/mini-gastric bypass to Roux-en-Y gastric bypass (RYGB) is an important point. Even in patients undergoing RYGB, marginal ulcer is regarded as a known complication.
In our Centre of Excellence in Bariatric and Metabolic Surgery, 2492 patients underwent OAGB from February 2012 to January 2019. Twelve of 2492 patients were enrolled in this clinical case series because of persistent gastroesophageal reflux-like symptoms which underwent conversional RYGB. All patients regularly received proton-pump inhibitors (PPIs) for 6 months after the surgery. After this period, the cases with symptomatic reflux were invited to be visited in the clinic by a bariatric surgeon and a gastroenterologist and received 6 months of PPI therapy until their symptoms disappeared. Twelve refractory reflux cases underwent conversional RYGB after 1 year. An enteroenterostomy was created in all the patients 75 cm distal to the gastrojejunostomy without resizing the gastric pouch, and the jejunal loop was cut just before the gastrojejunostomy.
Before conversional surgery, mean ± standard deviation (SD) body mass index (BMI) and gastroesophageal reflux disease (GERD)-Q score were found to be 26.45 ± 2.34 kg/m and 10.08 ± 0.56, respectively. At 1 year after conversion, mean ± SD BMI in the patients was 28.12 ± 4.71, and GERD-Q score was 5.08 ± 1.5.
It seems that resizing the gastric pouch is not necessary during the conversion of OAGB to RYGB.
在将单吻合口胃旁路术（OAGB）/迷你胃旁路术转换为 Roux-en-Y 胃旁路术（RYGB）的过程中，调整胃囊大小是一个重要问题。即使在接受 RYGB 手术的患者中，边缘溃疡也被视为一种已知的并发症。
在我们的肥胖与代谢外科卓越中心，2012 年 2 月至 2019 年 1 月期间有 2492 例患者接受了 OAGB 手术。2492 例患者中有 12 例因持续性胃食管反流样症状而被纳入本临床病例系列，接受了转换为 RYGB 的手术。所有患者术后均规律服用质子泵抑制剂（PPI）6 个月。在此期间后，有症状性反流的病例由肥胖症外科医生和胃肠病学家邀请到门诊就诊，并接受 6 个月的 PPI 治疗，直至症状消失。12 例难治性反流病例在 1 年后接受了转换为 RYGB 的手术。所有患者在胃空肠吻合口远端 75 cm 处进行肠肠吻合，未调整胃囊大小，空肠袢在胃空肠吻合术前切断。
转换手术前，平均±标准差（SD）体重指数（BMI）和胃食管反流病（GERD）-Q 评分分别为 26.45±2.34 kg/m²和 10.08±0.56。转换后 1 年，患者的平均±SD BMI 为 28.12±4.71，GERD-Q 评分为 5.08±1.5。
在将 OAGB 转换为 RYGB 的过程中，似乎没有必要调整胃囊大小。
