Vennapusa Amar, Panchangam Ramakanth Bhargav, Kesara Charita, Mallick Nazneen
Department of Bariatric and Metabolic Surgery, Dr. Amar Bariatric & Metabolic Center, Hyderabad, Telangana, India.
Department of Endocrine and Metabolic Surgery, Endocare Hospital, Vijayawada, India.
J Minim Invasive Surg. 2021 Mar 15;24(1):10-17. doi: 10.7602/jmis.2021.24.1.10.
Laparoscopic sleeve gastrectomy (SG) with loop duodenojejunal bypass (LDJB) is a combination of SG and one anastomosis gastric bypass surgeries. This study was intended to evaluate the safety and feasibility of SG-LDJB surgery.
This was a retrospective study analyzing SG-LDJB surgery using 250-cm length biliopancreatic limbs that was performed between May 2013 and December 2017 in 113 Indians with obesity. All demographic, clinical, operative, and follow-up data were analyzed for weight loss and diabetes remission efficacy. Weight-loss success was defined as percentage of total weight loss (%TWL) ≥ 25%. Diabetes remission was defined as hemoglobin A1c < 6% without the need for antidiabetic medications. Safety and feasibility were analyzed in terms of intraoperative and postoperative complications and serum albumin, iron, and calcium levels.
The %TWL was 35.0% and 31.0% at the 1-year and 3-year follow-ups, respectively. The weight-loss success rate was 91.3% and 78.1% at the 1-year and 3-year follow-ups, respectively. Sixty-six out of 113 patients had type 2 diabetes. Diabetes remission was 80.0% and 75.4% at the 1-year and 3-year follow-ups, respectively. Major perioperative complications occurred in 0.9% of the patients. The 30-day mortality rate was zero. None of the patients had serum albumin levels of <3 g/dL at the 1-year and 3-year follow-ups or symptoms of hypoproteinemia.
SG-LDJB surgery using a 250-cm biliopancreatic limb is a safe and effective procedure to treat obesity. It is technically complex but has the advantages of endoscopic access to the stomach and negligible postoperative complications or hypoproteinemia.
腹腔镜袖状胃切除术（SG）联合袢式十二指肠空肠旁路术（LDJB）是SG与单吻合口胃旁路手术的联合术式。本研究旨在评估SG-LDJB手术的安全性和可行性。
这是一项回顾性研究，分析了2013年5月至2017年12月期间对113例肥胖印度患者实施的使用250厘米长胆胰支的SG-LDJB手术。分析了所有人口统计学、临床、手术及随访数据，以评估体重减轻和糖尿病缓解疗效。体重减轻成功定义为总体重减轻百分比（%TWL）≥25%。糖尿病缓解定义为糖化血红蛋白<6%且无需使用抗糖尿病药物。从术中及术后并发症以及血清白蛋白、铁和钙水平方面分析安全性和可行性。
1年和3年随访时的%TWL分别为35.0%和31.0%。1年和3年随访时的体重减轻成功率分别为91.3%和78.1%。113例患者中有66例患有2型糖尿病。1年和3年随访时的糖尿病缓解率分别为80.0%和75.4%。0.9%的患者发生了主要围手术期并发症。30天死亡率为零。在1年和3年随访时，没有患者的血清白蛋白水平<3 g/dL或出现低蛋白血症症状。
使用250厘米胆胰支的SG-LDJB手术是治疗肥胖的一种安全有效的手术方法。它技术上较为复杂，但具有通过内镜进入胃部的优点，且术后并发症或低蛋白血症可忽略不计。
