Division of General Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel.
Sackler's Faculty of Medicine, Tel-Aviv University, Tel Aviv 6997801, Israel.
Nutrients. 2022 Jun 6;14(11):2356. doi: 10.3390/nu14112356.
One anastomosis gastric bypass (OAGB) is safe and effective. Its strong malabsorptive component might cause severe protein-energy malnutrition (PEM), necessitating revisional surgery. We aimed to evaluate the safety and outcomes of OAGB revision for severe PEM.
This was a single-center retrospective analysis of OAGB patients undergoing revision for severe PEM (2015-2021). Perioperative data and outcomes were retrieved.
Ten patients underwent revision for severe PEM. Our center's incidence is 0.63% (9/1425 OAGB). All patients were symptomatic. Median (interquartile range) EWL and lowest albumin were 103.7% (range 57.6, 114) and 24 g/dL (range 19, 27), respectively, and 8/10 patients had significant micronutrient deficiencies. Before revision, nutritional optimization was undertaken. Median OAGB to revision interval was 18.4 months (range 15.7, 27.8). Median BPL length was 200 cm (range 177, 227). Reversal ( = 5), BPL shortening ( = 3), and conversion to Roux-en-Y gastric bypass (RYGB) ( = 2) were performed. One patient had anastomotic leak after BPL shortening. No death occurred. Median BMI and albumin increased from 22.4 kg/m (range 20.6, 30.3) and 35.5 g/dL (range 29.2, 41), respectively, at revision to 27.5 (range 22.2, 32.4) kg/m and 39.5 g/dL (range 37.2, 41.7), respectively, at follow-up (median 25.4 months, range 3.1, 45). Complete resolution occurs after conversion to RYGB or reversal to normal anatomy, but not after BPL shortening.
Revisional surgery of OAGB for severe PEM is feasible and safe after nutritional optimization. Our results suggest that the type of revision may be an important factor for PEM resolution. Comparative studies are needed to define the role of each revisional option.
单吻合口胃旁路术（OAGB）是安全有效的。其强烈的吸收不良成分可能导致严重的蛋白质能量营养不良（PEM），需要进行修正手术。我们旨在评估 OAGB 修正术治疗严重 PEM 的安全性和结果。
这是一项对因严重 PEM 而接受 OAGB 修正术的患者进行的单中心回顾性分析（2015-2021 年）。检索了围手术期数据和结果。
10 例患者因严重 PEM 接受修正术。我们中心的发生率为 0.63%（9/1425 OAGB）。所有患者均有症状。中位（四分位距）EWL 和最低白蛋白分别为 103.7%（范围 57.6，114）和 24 g/dL（范围 19，27），8/10 例患者有明显的微量营养素缺乏。修正术前进行了营养优化。中位 OAGB 至修正间隔为 18.4 个月（范围 15.7，27.8）。中位 BPL 长度为 200cm（范围 177，227）。进行了反转（=5）、BPL 缩短（=3）和转换为 Roux-en-Y 胃旁路术（RYGB）（=2）。1 例患者在 BPL 缩短后发生吻合口漏。无死亡发生。中位 BMI 和白蛋白分别从修正时的 22.4kg/m（范围 20.6，30.3）和 35.5g/dL（范围 29.2，41）增加到随访时的 27.5（范围 22.2，32.4）kg/m 和 39.5g/dL（范围 37.2，41.7）（中位随访时间为 25.4 个月，范围 3.1，45）。在转换为 RYGB 或恢复正常解剖结构后完全缓解，但在 BPL 缩短后则不会。
在营养优化后，OAGB 修正术治疗严重 PEM 是可行且安全的。我们的结果表明，修正类型可能是 PEM 缓解的一个重要因素。需要进行比较研究来确定每种修正选择的作用。
