Chief Department of General and Metabolic Surgery, Rovigo Hospital, Rovigo, Italy.
Department of Surgery, San Valentino Montebelluna Hospital, Treviso, Italy.
Obes Surg. 2022 Sep;32(9):3194-3204. doi: 10.1007/s11695-022-06174-x. Epub 2022 Jun 28.
In case of insufficient weight loss or weight regain or relapse of weight-related comorbidities after Roux-en-Y gastric bypass (RYGB), other procedures such as reduction of a large gastric pouch and stoma, lengthening of the Roux limb, conversion to sleeve gastrectomy and/or bilio-pancreatic diversion with duodenal switch have been advocated. Single anastomosis jejuno-ileal (SAJI) is a new revisional simple operation performed after RYGB failure which adds malabsorption to the previous gastric bypass.
SAJI includes a single jejuno-ileal anastomosis specifically joining the ileum 250-300 cm proximal to the ileo-caecal valve and the jejunum 30 cm below the gastro-jejunal anastomosis on the Roux limb of the previous RYGB. Thirty-one patients underwent SAJI for insufficient weight loss and/or weight regain after RYGB. The percent total weight loss (%TWL) after RYGB and before SAJI was 21.8 ± 7.8. All SAJI operations were performed laparoscopically. The SAJI mean operating time was 145 min.
Regarding weight loss after SAJI, %TWL is 27.2 ± 7.4, 31.2 ± 6.4, 33.7 ± 5.9 and 32.9 ± 5.2 at 12, 24, 36 and 48 months, respectively. Our series recorded a low rate of peri-operative and medium-term complications with a low grade of severity (Clavien-Dindo classification grade). One patient required reoperation 36 days after SAJI for epigastrium incarcerated incisional hernia at the previous RYGB laparotomy site. Mortality was 0. Comorbidity reduction/resolution after SAJI is 83.2% for type 2 diabetes mellitus, 42.8% for arterial hypertension, 72.8% for dyslipidemia and 45.3% for OSA.
Treatment of failed RYGB is challenging. SAJI is a less complicated, purely low invasive malabsorptive operation that should reach satisfactory %TWL and comorbidity reduction/resolution.
在 Roux-en-Y 胃旁路术（RYGB）后出现体重减轻不足、体重反弹或与体重相关的合并症复发的情况下，已经提倡其他程序，例如缩小大胃囊和吻合口、延长 Roux 肢体、转换为袖状胃切除术和/或带有十二指肠转位的胆胰分流术。单吻合口空肠回肠旁路术（SAJI）是在 RYGB 失败后进行的一种新的简单修正手术，它在前胃旁路术的基础上增加了吸收不良。
SAJI 包括一个单一的空肠回肠吻合术，具体是将回肠与回盲瓣近端 250-300cm 处和 Roux 肢体上胃空肠吻合术下方 30cm 处的空肠连接。31 例患者因 RYGB 后体重减轻不足和/或体重反弹而行 SAJI。RYGB 前和 SAJI 后的体重总减轻百分比（%TWL）分别为 21.8±7.8。所有的 SAJI 手术均在腹腔镜下进行。SAJI 的平均手术时间为 145 分钟。
关于 SAJI 后的体重减轻，分别在 12、24、36 和 48 个月时，%TWL 为 27.2±7.4、31.2±6.4、33.7±5.9 和 32.9±5.2。我们的系列记录了低围手术期和中期并发症发生率，严重程度低（Clavien-Dindo 分级）。1 例患者在 SAJI 后 36 天因前 RYGB 剖腹手术部位的上腹部切口疝而需要再次手术。死亡率为 0。SAJI 后 2 型糖尿病、动脉高血压、血脂异常和 OSA 的并发症减少/缓解率分别为 83.2%、42.8%、72.8%和 45.3%。
治疗 RYGB 失败是具有挑战性的。SAJI 是一种较不复杂、纯粹低侵入性的吸收不良手术，应达到满意的%TWL 和并发症减少/缓解。
