Department of Surgery, Lugano Regional Hospital, EOC, Via Tesserete, 6900, Lugano, Switzerland.
Department of Surgery, Locarno Regional Hospital, EOC, Via Dell'Ospedale, 6600, Locarno, Switzerland.
Langenbecks Arch Surg. 2022 Aug;407(5):1839-1850. doi: 10.1007/s00423-022-02485-w. Epub 2022 Mar 2.
Laparoscopic gastric plication (LGP) often requires reoperative bariatric surgery (RBS) due to complications and insufficient weight loss. The aim of our study was to assess perioperative morbidity and weight loss during follow-up in patients undergoing RBS after primary LGP for morbid obesity.
A search of PubMed, Web of Science, Cochrane Library, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using ("conversion"OR "revision*""OR "reoperat*")AND("gastric"OR "curvatur*")AND "plication." Studies were deemed eligible if data on RBS after LGP were provided. For each study, data were extracted and analyzed.
In the literature review, 291 articles were screened and 7 included. The studies covered a total of 367 patients, of whom 119 received a sleeve gastrectomy (SG), 85 a Roux-en-y gastric bypass (RYGB), 75 a one anastomosis-gastric bypass (OAGB), 45 a re-LGP, and 25 a jejuno-ileal bypass. After RBS, excess weight loss was 50.8 ± 6.5% at 6 months, 71.0 ± 7.7% at 12 months, and 89.0 ± 7.8% at 24 months. Operative time was 101.3 ± 14.6 min. Postoperatively, 18/255 patients (7.1%) had a complication, and leakage and reoperations were reported in 6/255 (2.4%) and 5/255 (2.0%) patients, respectively. Length of hospital stay was 3.1 ± 2.4 days. The quality of evidence was rated as "very low."
Despite limitations, this systematic review and meta-analysis showed that RBS after LGP has an acceptable rate of complications and is effective in terms of excess weight loss during follow-up. No specific operation (e.g., SG, RYGB, OAGB) can be suggested over another due to the lack of evidence.
腹腔镜胃折叠术（LGP）常因并发症和减重不足而需要再次接受减重手术（RBS）。我们的研究目的是评估因病态肥胖行初次 LGP 后再次接受 RBS 的患者的围手术期发病率和随访期间的减重效果。
根据系统评价和荟萃分析的首选报告项目（PRISMA）指南，在 PubMed、Web of Science、Cochrane 图书馆和 Google Scholar 上进行检索，使用“转换”或“修正”、“胃”或“曲率”和“折叠”进行搜索。如果提供了 LGP 后 RBS 的数据，则认为研究符合纳入标准。对每项研究的数据进行提取和分析。
在文献综述中，筛选了 291 篇文章，纳入了 7 篇文章。这些研究共纳入 367 例患者，其中 119 例行胃袖状切除术（SG），85 例行 Roux-en-y 胃旁路术（RYGB），75 例行单吻合胃旁路术（OAGB），45 例行再次 LGP，25 例行空肠回肠旁路术。再次接受 RBS 后，6 个月时的额外减重为 50.8%±6.5%，12 个月时为 71.0%±7.7%，24 个月时为 89.0%±7.8%。手术时间为 101.3±14.6 分钟。术后，255 例患者中有 18 例（7.1%）发生并发症，6 例（2.4%）发生漏液，5 例（2.0%）接受再次手术。住院时间为 3.1±2.4 天。证据质量评为“极低”。
尽管存在局限性，但本系统评价和荟萃分析显示，LGP 后再次接受 RBS 的并发症发生率可接受，并且在随访期间的额外减重效果方面是有效的。由于缺乏证据，无法推荐某种特定手术（如 SG、RYGB、OAGB）优于其他手术。
