Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.
Weight Management Center, Kaohsiung Medical University Hospital/Kaohsiung Medical University, Kaohsiung City, Taiwan.
Obes Surg. 2021 Aug;31(8):3653-3659. doi: 10.1007/s11695-021-05466-y. Epub 2021 May 12.
Laparoscopic gastric clipping (LGC) is a relatively novel restrictive bariatric surgery wherein a horizontal metallic clip is applied to the gastric fundus. Its intraoperative complications or the difficulties associated with the applied gastric clip (GC) during revisional procedures have seldom been mentioned. Herein, the experience of revisional procedures after initial gastric clipping is reported.
A retrospective cohort review of LGC based on the Taiwan Bariatric Registry of Taiwan Society Metabolic and Bariatric Surgery was performed. Six patients with severe obesity presented for revisional surgery after initial LGC by other surgeons. Patients' characteristics, indications, and details of revisional surgery were recorded.
Between 2012 and 2019, 39 patients who underwent pure LGC and six patients with previous LGC history were referred for revisional surgery. Their mean age and the mean body mass index were 34.7 ± 9.5 years and 38.4 ± 10.5 kg/m, respectively. Three, two, and one patient underwent revisional surgery for insufficient weight loss, weight recidivism, and intractable belching, respectively. The mean interval between initial LGC and revisional surgery was 40.5 ± 22.4 months. Laparoscopic removal of the GC with concomitant revisional surgeries were collected, including a revision to sleeve gastrectomy (n = 5) and revision to Roux-en-Y gastric bypass (n = 1). Moreover, the mean operative time was 286.8 ± 78.2 min. All patients had uneventful recovery postoperatively but experienced significant adhesion around the GC and the left liver.
Laparoscopic revisional surgery with concomitant GC removal for patients with severe obesity after gastric clipping could be feasibly conducted by experienced bariatric surgeons.
腹腔镜胃夹（LGC）是一种相对较新的限制型减重手术，术中在胃底部应用水平金属夹。很少有文献报道其术中并发症或在翻修手术中应用胃夹（GC）时遇到的困难。本文报告了初次胃夹后进行翻修手术的经验。
对台湾代谢和减重外科学会台湾减重注册中心的 LGC 进行回顾性队列研究。6 例由其他外科医生行初次 LGC 后因严重肥胖就诊行翻修手术的患者纳入研究。记录患者的特征、适应证和翻修手术的细节。
2012 年至 2019 年，共有 39 例单纯行 LGC 患者和 6 例有 LGC 史的患者转诊行翻修手术。患者的平均年龄和平均体重指数分别为 34.7±9.5 岁和 38.4±10.5kg/m²。3 例、2 例和 1 例患者分别因减重不足、体重反弹和顽固性呃逆而行翻修手术。初次 LGC 与翻修手术之间的平均间隔时间为 40.5±22.4 个月。腹腔镜下取出 GC 并同时行翻修手术，包括袖状胃切除术（n=5）和 Roux-en-Y 胃旁路术（n=1）。此外，平均手术时间为 286.8±78.2min。所有患者术后均顺利康复，但均出现 GC 周围和左肝周围明显粘连。
对于严重肥胖患者，经验丰富的减重外科医生可以安全地行腹腔镜下翻修手术，同时取出 GC。
