Division of General Surgery, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64230906, Tel Aviv, Israel.
Division of General Surgery, Bariatric Unit, Tel Aviv Sourasky Medical Center, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Obes Surg. 2022 Oct;32(10):3264-3271. doi: 10.1007/s11695-022-06235-1. Epub 2022 Aug 11.
Revisional one anastomosis gastric bypass (OAGB) for insufficient weight reduction following primary restrictive procedures is still investigated. We report mid-term outcomes and possible outcome predictors.
Single-center retrospective comparative study of revisional OAGB outcomes (2015-2018) following laparoscopic adjustable gastric banding (LAGB) and sleeve gastrectomy (SG); silastic ring vertical gastroplasty (SRVG) is separately discussed.
In all, 203 patients underwent revisional OAGB following LAGB (n = 125), SG (n = 64), and SRVG (n = 14). Comparing LAGB and SG, body mass index (BMI) at revision were 41.3 ± 6.6 and 42 ± 11.2 kg/m (p = 0.64), reduced to 31.3 ± 8.3 and 31.9 ± 8.3 (p = 0.64) at mid-term follow-up, respectively. Excess weight loss (EWL) > 50% was achieved in ~ 50%, with EWL of 79.4 ± 20.4% (corresponding total weight loss 38.5 ± 10.4%). SRVG patients had comparable outcomes. Resolution rates of type 2 diabetes (T2D) and hypertension (HTN) were 93.3% and 84.6% in LAGB compared with 100% and 100% in SG patients (p = 0.47 and p = 0.46), respectively. In univariable analysis, EWL > 50% was associated with male gender (p < 0.001), higher weight (p < 0.001), and BMI (p = 0.007) at primary surgery, and higher BMI at revisional OAGB (p < 0.001). In multivariable analysis, independent predictors for EWL > 50% were male gender (OR = 2.8, 95% CI 1.27-6.18; p = 0.01) and higher BMI at revisional OAGB (OR = 1.11, 95% CI 1.03-1.19; p = 0.006).
Revisional OAGB for insufficient restrictive procedures results in excellent weight reduction in nearly 50% of patients, with resolution of T2D and HTN at mid-term follow-up. Male gender and higher BMI at revision were associated with EWL > 50% following revisional OAGB. Identification of more predictors could aid judicious patient selection.
对于初次施行限制型手术之后减重效果不理想的患者，可进行再次吻合胃旁路手术（one anastomosis gastric bypass，OAGB）。我们报告了中期结果和可能的结果预测因素。
这是一项单中心回顾性对比研究，比较了腹腔镜可调节胃束带术（laparoscopic adjustable gastric banding，LAGB）和袖状胃切除术（sleeve gastrectomy，SG）之后行再次吻合胃旁路手术（revisional OAGB）的结果，同时单独讨论了硅酮环垂直胃成形术（silastic ring vertical gastroplasty，SRVG）。
共有 203 例患者因初次施行 LAGB（n = 125）、SG（n = 64）或 SRVG（n = 14）之后减重效果不理想而接受了再次吻合胃旁路手术。LAGB 和 SG 组患者的体重指数（body mass index，BMI）在初次手术时分别为 41.3 ± 6.6 和 42 ± 11.2 kg/m²（p = 0.64），在中期随访时分别降至 31.3 ± 8.3 和 31.9 ± 8.3（p = 0.64）。再次吻合胃旁路手术后，大约 50%的患者达到了 excess weight loss（EWL）> 50%，EWL 为 79.4 ± 20.4%（相应的总体减重为 38.5 ± 10.4%）。SRVG 组患者的结果也具有可比性。与 SG 组患者相比，LAGB 组患者的 2 型糖尿病（type 2 diabetes，T2D）和高血压（hypertension，HTN）的缓解率分别为 93.3%和 84.6%（p = 0.47 和 p = 0.46）。在单变量分析中，EWL> 50%与男性（p < 0.001）、更高的体重（p < 0.001）和初次手术时的 BMI（p = 0.007）相关，与再次吻合胃旁路手术时的 BMI（p < 0.001）相关。在多变量分析中，EWL> 50%的独立预测因素为男性（odds ratio，OR = 2.8，95% confidence interval，CI 1.27-6.18；p = 0.01）和再次吻合胃旁路手术时更高的 BMI（OR = 1.11，95% CI 1.03-1.19；p = 0.006）。
对于初次施行限制型手术之后减重效果不理想的患者，再次吻合胃旁路手术可获得极好的减重效果，大约 50%的患者达到了 EWL> 50%，并可在中期随访时缓解 2 型糖尿病和高血压。男性和再次吻合胃旁路手术时更高的 BMI 与再次吻合胃旁路手术后 EWL> 50%相关。进一步识别更多的预测因素可能有助于进行明智的患者选择。
