袖状胃切除术失败后的修复术式：腹腔镜下胃旁路术或 Roux-n-Y 胃旁路术对比——一项多中心研究。
Sleeve Gastrectomy Failure-Revision to Laparoscopic One-Anastomosis Gastric Bypass or Roux-n-Y Gastric Bypass: a Multicenter Study.
机构信息
Department of Surgery C, Chaim Sheba Medical Center, 2 Sheba Rd., 52610, Ramat Gan, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
出版信息
Obes Surg. 2021 Jul;31(7):2927-2934. doi: 10.1007/s11695-021-05334-9. Epub 2021 Mar 25.
INTRODUCTION
Laparoscopic sleeve gastrectomy (LSG) is the most popular bariatric procedure performed worldwide. However, many patients undergo secondary surgery due to either weight-related and complication-related reasons or both. Conversional options vary with one-anastomosis gastric bypass (OAGB) and Roux-n-Y gastric bypass (RYGB) being the most common. The aim of the study was to assess the safety and efficacy of converting failed LSG to either OAGB or RYGB, and compare weight-related results and post-conversion complications.
METHODS
Retrospective review of hospital records of patients who underwent conversion from LSG to either RYGB or OAGB due to insufficient weight loss or weight regain in 7 bariatric centers between 2013 and 2019. Data retrieved included demographics, anthropometrics, comorbidities, indication for conversion, conversion type, complications, and weight loss.
RESULTS
During the study period, 396 patients were included in the study. Eighty-four (21%) patients were lost to follow-up. RYGB and OAGB were performed in 119 and 144 patients, respectively. Mean age and body mass index (BMI) at revision were 44.2 years (range 19-72) and 40.6 ± 5.9 kg/m (range 35-71), respectively. Of these, 191 (73%) were female. Percent total body weight loss (%TWL) was 16% ± 1% for the RYGB group vs. 23% ± 12% for the OAGB group (p = 0.0007) at a median follow-up of 29 months (range 7-78 months) following conversion. Gastroesophageal reflux disease (GERD) was significantly higher 1 year following conversion to OAGB vs. RYGB occurring in 25 (17.4%) and 9 (7.6%) patients, respectively (p = 0.018).
CONCLUSIONS
Conversion of LSG to OAGB, compared to RYGB, results in increased weight loss but a higher rate of GERD and potential nutritional deficiencies.
简介
腹腔镜袖状胃切除术（LSG）是全球应用最广泛的减重手术。然而，许多患者因体重相关和并发症相关原因或两者兼而有之而需要进行二次手术。转换的选择因术式而异，其中单吻合口胃旁路术（OAGB）和 Roux-en-Y 胃旁路术（RYGB）最为常见。本研究旨在评估将失败的 LSG 转换为 OAGB 或 RYGB 的安全性和有效性，并比较体重相关结果和转换后的并发症。
方法
回顾性分析了 2013 年至 2019 年期间在 7 个减重中心接受 LSG 转为 OAGB 或 RYGB 的患者的医院病历，这些患者因减重不足或体重反弹而进行了转换。收集的数据包括人口统计学、人体测量学、合并症、转换指征、转换类型、并发症和减重情况。
结果
在研究期间，共有 396 例患者纳入研究。84 例（21%）患者失访。RYGB 和 OAGB 分别在 119 例和 144 例患者中进行。修正时的平均年龄和体重指数（BMI）分别为 44.2 岁（范围 19-72）和 40.6 ± 5.9 kg/m²（范围 35-71），其中 191 例（73%）为女性。RYGB 组的总体体重减轻百分比（%TWL）为 16% ± 1%，OAGB 组为 23% ± 12%（p = 0.0007），随访中位数为 29 个月（范围 7-78 个月）。OAGB 转换后 1 年，胃食管反流病（GERD）的发生率明显高于 RYGB，分别为 25 例（17.4%）和 9 例（7.6%）（p = 0.018）。
结论
与 RYGB 相比，LSG 转为 OAGB 可增加减重效果，但 GERD 和潜在营养缺乏的发生率更高。
Zotero 插件