Lee Ming-Hsien, Almalki Owaid M, Lee Wei-Jei, Soong Tien-Chou, Chen Shu-Chun
Metabolic & Bariatric Surgical Department, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taiwan, ROC.
Department of Surgery, College of Medicine, Taif University, Saudi Arabia.
Asian J Surg. 2023 Feb;46(2):761-766. doi: 10.1016/j.asjsur.2022.07.003. Epub 2022 Jul 14.
Sleeve gastrectomy (SG) is the most performed bariatric procedure now. Some patients would necessitate a revision to Roux-en-Y gastric bypass (RYGB) as a salvage procedure for intractable gastroesophageal reflux disease (GERD). However, outcome of the revision in Asians with co-existed obesity and those non-obese is not clear.
We retrospectively reviewed the data of patients who underwent revisional laparoscopic RYGB after SG between 2007 and 2019 for intractable GERD with data of one year follow-up. Pre-operative clinical data, perioperative outcomes, GERD symptoms, weight loss and medication details were analyzed. Patients were classified into those with body mass index (BMI) ≥ 25 and < 25 kg/m.
Fifty-five patients (44 women, 11 men; mean age 42.5 years) were included. Mean interval from the initial SG to revision surgery was 51.2 months (range, 5-132). Mean body mass index before SG was 34.6 kg/m, whereas that before revision surgery was 27.6 kg/m. All the patients required continue proton pump inhibitor (PPI) to control the GERD symptoms before surgery. Among them, 36 (65.4%) patients in the obese group received long BP limb (>100 cm) RYGB for associated obesity but the common channel was assured to ≥ 400 cm or 70% of small bowel length, the other 19 (34.6%) patients in the non-obese group received standard BP limb (<100 cm) RYGB. There was no difference in basic characters between the two groups before revision surgery except a higher mean BMI (30.0 vs. 22.2 kg/m, p < 0.001), blood pressure and triglyceride in obese group. One year after revision surgery, all the patients had improved GERD symptoms but only 33 (60%) can completely wave PPI, without difference between the 2 groups. Obese group with a long BP limb RYGB had a significant higher % total weight loss (TWL) than non-obese group (%TWL 9.1% vs. -3.1%, p = 0.005).
Laparoscopic revision to RYGB is a safe and effective treatment for patients with intractable GERD after SG but some patients may still have residual GERD symptoms. Using a modified RYGB technique in revision surgery may help in weight reduction for obese Asian patients.
袖状胃切除术（SG）是目前最常用的减肥手术。一些患者因顽固性胃食管反流病（GERD）需要翻修为Roux-en-Y胃旁路术（RYGB）作为挽救手术。然而，亚洲肥胖合并症患者和非肥胖患者的翻修结果尚不清楚。
我们回顾性分析了2007年至2019年间因顽固性GERD接受腹腔镜RYGB翻修手术患者的资料，并进行了一年的随访。分析术前临床资料、围手术期结果、GERD症状、体重减轻和用药细节。患者分为体重指数（BMI）≥25和<25kg/m²两组。
纳入55例患者（44例女性，11例男性；平均年龄42.5岁）。从初次SG到翻修手术的平均间隔时间为51.2个月（范围5-132个月）。SG术前平均BMI为³⁴.⁶kg/m²，而翻修术前为²⁷.⁶kg/m²。所有患者术前均需持续使用质子泵抑制剂（PPI）控制GERD症状。其中，肥胖组36例（65.4%）患者因合并肥胖接受长BP肢（>100cm）RYGB，但共同通道确保≥400cm或小肠长度的70%，非肥胖组19例（34.6%）患者接受标准BP肢（<100cm）RYGB。翻修术前两组患者基本特征无差异，仅肥胖组平均BMI较高（30.0 vs. 22.2kg/m²，p<0.001），血压和甘油三酯较高。翻修手术后一年，所有患者GERD症状均有改善，但只有33例（60%）患者可完全停用PPI，两组之间无差异。肥胖组采用长BP肢RYGB的总体重减轻百分比（%TWL）显著高于非肥胖组（%TWL 9.1% vs. -3.1%，p=0.005）。
腹腔镜翻修为RYGB是治疗SG术后顽固性GERD患者的一种安全有效的方法，但部分患者仍可能残留GERD症状。在翻修手术中采用改良的RYGB技术可能有助于肥胖亚洲患者减轻体重。
