Clarunis, Department of Visceral Surgery, University Centre for Gastrointestinal and Liver Diseases, St. Clara Hospital and University Hospital Basel, 4002, Basel, Switzerland.
Obesity & Bariatric Surgery Centre, Department of Surgery, Limmattal Hospital, 8952, Zurich-Schlieren, Switzerland.
J Gastrointest Surg. 2021 Dec;25(12):3056-3063. doi: 10.1007/s11605-021-05045-7. Epub 2021 Jun 7.
A subset of patients undergoing Roux-en-Y gastric bypass (RYGB) presents with either insufficient weight loss or weight regain. Data on the revisional restrictive options including laparoscopic adjustable gastric band (LAGB) is scarce. This study analyzes the mid-term efficacy and safety of LAGB as a revisional procedure after RYGB.
Data of all patients with revisional LAGB after primary RYGB between January 2011 and May 2019 were retrospectively reviewed. Outcomes included assessment of weight changes, resolution of comorbidities, and early and late complications during the study period.
Twenty patients were included. The median Body Mass Index (BMI) before revisional LAGB was 34.8 (interquartile range [IQR] 31.9-38.1) kg/m. After a median follow-up of 33.5 (IQR 19.5-76.5) months, the median BMI was 28.7 (IQR 26.1-32.2) kg/m. The median additional Excess Weight Loss (EWL) was 37.6% (IQR 23-44.4), leading to a median total EWL of 79.5% (IQR 54.4-94.6). BMI and EWL post-LAGB improved significantly compared to BMI and EWL pre-LAGB (p<0.001 and p<0.001, respectively). Obstructive sleep apnea syndrome resolved 6 months after LAGB in one patient. Three band deflations occurred during the follow-up. Six patients underwent band removal after a median time of 19 (IQR 15.8-26) months. Overall, thirteen patients underwent a reoperation. There was no loss of follow-up until 5 years. After that, two patients were lost to follow-up.
LAGB may be a salvage option after failed RYGB. However, the high rate of revisions after secondary LAGB needs to be taken into consideration.
接受 Roux-en-Y 胃旁路术（RYGB）的患者中，有一部分存在减重不足或体重反弹的情况。关于包括腹腔镜可调节胃束带术（LAGB）在内的限制性修正选择的数据很少。本研究分析了 LAGB 作为 RYGB 后的修正手术的中期疗效和安全性。
回顾性分析 2011 年 1 月至 2019 年 5 月期间所有因初次 RYGB 而行 LAGB 修正术的患者数据。研究期间的结局包括体重变化评估、合并症缓解情况以及早期和晚期并发症。
共纳入 20 例患者。行 LAGB 修正术前的中位体重指数（BMI）为 34.8（四分位距[IQR]31.9-38.1）kg/m。中位随访 33.5（IQR19.5-76.5）个月后，BMI 中位数为 28.7（IQR26.1-32.2）kg/m。中位额外体重减轻率（EWL）为 37.6%（IQR23-44.4），导致总 EWL 中位数为 79.5%（IQR54.4-94.6）。与 LAGB 前相比，LAGB 后 BMI 和 EWL 显著改善（p<0.001 和 p<0.001）。1 例患者在 LAGB 后 6 个月时阻塞性睡眠呼吸暂停综合征缓解。随访期间发生 3 次束带放气。中位时间 19（IQR15.8-26）个月后 6 例患者行带取出术。总体而言，13 例患者行再次手术。5 年内无失访，之后有 2 例失访。
LAGB 可能是 RYGB 失败后的挽救选择。然而，需要考虑二次 LAGB 后较高的修正率。
