Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
Department of Medicine, Royal College of Surgeons Ireland, Dublin, Ireland.
Obes Surg. 2021 Sep;31(9):3936-3946. doi: 10.1007/s11695-021-05463-1. Epub 2021 Jul 3.
Sleeve gastrectomy (SG) is the most performed bariatric procedure. Conversion to Roux-en-Y gastric bypass (RYGB) for SG-related complications such as gastroesophageal reflux disease (GERD), insufficient weight loss (ISWL), and weight regain (WR) is increasing. Our aim was to investigate the safety, efficacy, and outcomes of conversion from SG to RYGB.
A literature search was performed from database inception to May 2020. Eligible studies must report indications for conversion, %total body weight loss (%TWL), and/or complications. The pooled mean or proportion were analyzed using a random-effects model.
Seventeen unique studies (n = 556, 68.7% female, average age at time of conversion 42.6 ± 10.29 years) were included. The pooled conversion rate due to GERD was 30.4% (95% CI 23.5, 38.3%; I = 63.9%), compared to 52.0% (95% CI 37.0, 66.6%; I = 85.89%) due to ISWL/WR. The pooled baseline BMI at conversion was 38.5 kg/m (95% CI 36.49, 40.6 kg/m; I = 92.1%) and after 1 year was 32.1 kg/m (95% CI 25.50, 38.7 kg/m; I = 94.53%). The pooled %TWL after 1 year was 22.8% (95% CI 13.5, 32.1%; I = 98.05%). Complication rate within 30 days was 16.4% (95% CI 11.1, 23.6%; I = 57.17%), and after 30 days was 11.4% (95% CI 7.7, 16.7%; I = 0%).
This meta-analysis showed that conversion from SG to RYGB is an option for conversion at a bariatric care center that produces sufficient weight loss outcomes, and potential resolution of symptoms of GERD. Further indication-based studies are required to obtain a clearer consensus on the surgical management of patients seeking RYGB following SG.
袖状胃切除术（SG）是最常施行的减重手术。由于胃食管反流病（GERD）、减重不足（ISWL）和体重反弹（WR）等 SG 相关并发症，越来越多的患者需要将其转换为 Roux-en-Y 胃旁路术（RYGB）。本研究旨在探讨 SG 转换为 RYGB 的安全性、疗效和结局。
从数据库创建到 2020 年 5 月进行文献检索。合格的研究必须报告转换的适应证、体重减轻百分比（%TWL）和/或并发症。采用随机效应模型分析汇总的平均值或比例。
纳入了 17 项独特的研究（n=556，女性占 68.7%，转换时的平均年龄为 42.6±10.29 岁）。由于 GERD 进行转换的汇总转化率为 30.4%（95%CI 23.5，38.3%；I=63.9%），而由于 ISWL/WR 进行转换的比例为 52.0%（95%CI 37.0，66.6%；I=85.89%）。转换时的基线 BMI 汇总值为 38.5kg/m（95%CI 36.49，40.6kg/m；I=92.1%），1 年后为 32.1kg/m（95%CI 25.50，38.7kg/m；I=94.53%）。1 年后的汇总%TWL 为 22.8%（95%CI 13.5，32.1%；I=98.05%）。30 天内的并发症发生率为 16.4%（95%CI 11.1，23.6%；I=57.17%），30 天后为 11.4%（95%CI 7.7，16.7%；I=0%）。
本荟萃分析表明，对于减重治疗中心的患者，SG 转换为 RYGB 是一种选择，可获得令人满意的减重效果，并可能缓解 GERD 症状。需要进一步进行基于适应证的研究，以获得对 SG 后寻求 RYGB 手术治疗的患者的手术管理更明确的共识。
