Wijngaarden L H, Reiber B M M, Yousufzai F, Demirkiran A, Klaassen R A
Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands.
Surg Endosc. 2022 May;36(5):3495-3503. doi: 10.1007/s00464-021-08671-z. Epub 2021 Aug 10.
Insufficient weight loss or weight regain has many causes including a large gastric pouch. A large gastric pouch may be due to the surgical technique or can be patient related (dilation). Resizing the gastric pouch may lead to additional weight loss. Currently, there is no gold standard for the revisional surgical technique. Therefore this study was performed to determine which surgical technique for revisional bariatric surgery (BS) has superior outcomes in terms of weight loss: sleeve resection of the gastrojejunostomy and gastric pouch (SGP), or resection of the gastrojejunostomy with resizing of the pouch and creation of a new anastomosis (RGJ).
All patients who underwent revisional BS for insufficient weight loss or weight regain as a result of an enlarged pouch after LRYGB from April 2014 to June 2018 in our hospitals were included in this observational cohort study. Outcomes were measured in percentage total weight loss (%TWL).
A total of 37 patients who underwent SGP and 21 patients who underwent RGJ as revisional BS were included in this study. The median body mass index before revisional BS was 37.6 kg/m versus 35.7 kg/m (SGP vs RGJ, respectively, P = 0.115). There was no significant difference in %TWL between the two cohorts 1 and 2 years after revisional BS, respectively; SGP 14.5% vs RGJ 11.0%, P = 0.885 and SGP 12.3% vs RGJ 10.8%, P = 0.604. Comparing %TWL based on weight at LRYGB, there was also no significant difference two years after revisional BS (SGP 22.0% vs RGJ 22.2%, P = 0.885). The average use of surgical disposables for the SGP technique were lower compared to the RGJ technique.
Resizing a large pouch leads to additional weight loss. Both techniques have comparable outcomes in terms of weight loss. However, based on average surgical costs, the SGP technique may be preferable.
体重减轻不足或体重反弹有多种原因，包括胃囊过大。胃囊过大可能是由于手术技术问题，也可能与患者自身因素（扩张）有关。缩小胃囊可能会带来额外的体重减轻。目前，翻修手术技术尚无金标准。因此，本研究旨在确定哪种减肥手术翻修技术在体重减轻方面具有更好的效果：胃空肠吻合口和胃囊袖状切除术（SGP），还是胃空肠吻合口切除术并缩小胃囊并创建新的吻合口（RGJ）。
2014年4月至2018年6月在我院因腹腔镜Roux-en-Y胃旁路术（LRYGB）后胃囊增大导致体重减轻不足或体重反弹而接受减肥手术翻修的所有患者均纳入本观察性队列研究。结果以总体重减轻百分比（%TWL）衡量。
本研究共纳入37例行SGP翻修减肥手术的患者和21例行RGJ翻修减肥手术的患者。翻修减肥手术前的中位体重指数分别为37.6kg/m²和35.7kg/m²（SGP组和RGJ组，P = 0.115）。翻修减肥手术后1年和2年，两组的%TWL无显著差异；SGP组为14.5%，RGJ组为11.0%，P = 0.885；SGP组为12.3%，RGJ组为10.8%，P = 0.604。基于LRYGB时的体重比较%TWL，翻修减肥手术后两年也无显著差异（SGP组为22.0%，RGJ组为22.2%，P = 0.885）。与RGJ技术相比，SGP技术的手术一次性用品平均使用量较低。
缩小大胃囊可带来额外的体重减轻。两种技术在体重减轻方面效果相当。然而，基于平均手术成本，SGP技术可能更可取。
