Dutch Obesity Clinic, Huis ter Heide, The Netherlands.
Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Obes Surg. 2021 Nov;31(11):4708-4716. doi: 10.1007/s11695-021-05609-1. Epub 2021 Aug 16.
Although the sleeve gastrectomy (SG) has good short-term results, it comes with a significant number of patients requiring revisional surgery because of insufficient weight loss or functional complications.
To investigate the effectiveness of the single anastomosis duodenoileal bypass (SADI-S) versus the Roux-en-Y gastric bypass (RYGB) on health outcomes in (morbidly) obese patients who had previously undergone SG, with up to 5 years of follow-up.
Data from patients who underwent revisional SADI-S or RYGB after SG were retrospectively compared on indication of surgery, weight loss, quality of life, micronutrient deficiencies, and complications.
From 2007 to 2017, 141 patients received revisional laparoscopic surgery after SG in three specialized Dutch bariatric hospitals (SADI-S n=63, RYGB n=78). Percentage total weight loss following revisional surgery at 1, 2, 3, 4, and 5 years was 22%, 24%, 22%, 18%, and 15% for SADI-S and 10%, 9%, 7%, 8%, and 2% for RYGB (P<.05 for 1-4 years). Patients who underwent RYGB surgery for functional complications experienced no persistent symptoms of GERD or dysphagia in 88% of cases. No statistical difference was found in longitudinal analysis of change in quality of life scores or cross-sectional analysis of complication rates and micronutrient deficiencies.
Conversion of SG to SADI-S leads to significantly more total weight loss compared to RYGB surgery with no difference in quality of life scores, complication rates, or micronutrient deficiencies. When GERD in sleeve patients has to be resolved, RYGB provides adequate outcomes.
尽管袖状胃切除术（SG）具有良好的短期效果，但仍有相当数量的患者因减重不足或出现功能并发症而需要接受再次手术。
研究单吻合口十二指肠空肠旁路术（SADI-S）与 Roux-en-Y 胃旁路术（RYGB）治疗先前接受 SG 术的肥胖症患者在健康结果方面的效果，随访时间长达 5 年。
回顾性比较了因手术指征、减重效果、生活质量、微量营养素缺乏和并发症而在三个荷兰专门的减重医院接受再次腹腔镜手术的 SADI-S 或 RYGB 治疗的 SG 后患者的数据。
2007 年至 2017 年，在三家荷兰专门的减重医院中，有 141 例患者在接受 SG 后接受了再次腹腔镜手术（SADI-S 组 63 例，RYGB 组 78 例）。再次手术后 1、2、3、4 和 5 年的总体重减轻百分比分别为 SADI-S 组 22%、24%、22%、18%和 15%，RYGB 组为 10%、9%、7%、8%和 2%（P<0.05 为 1-4 年）。因功能并发症而接受 RYGB 手术的患者中，88%的患者持续存在 GERD 或吞咽困难的症状得到缓解。在生活质量评分的纵向分析或并发症发生率和微量营养素缺乏的横断面分析中，均未发现统计学差异。
与 RYGB 手术相比，SG 转为 SADI-S 可显著减轻更多的体重，而生活质量评分、并发症发生率或微量营养素缺乏均无差异。当袖状胃患者的 GERD 需要解决时，RYGB 可提供足够的疗效。
