Roach Eileen, Laplante Simon, Stogryn Shannon, Maeda Azusa, Jackson Timothy, Okrainec Allan
Division of General Surgery, University Health Network, Toronto, ON, Canada.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Surg Endosc. 2023 Apr;37(4):3208-3214. doi: 10.1007/s00464-022-09506-1. Epub 2022 Aug 18.
Despite excellent reported outcomes after laparoscopic sleeve gastrectomy (LSG), a percentage of patients go on to have a secondary bariatric surgery to manage side-effects or address weight regain after LSG. Reported weight loss outcomes for patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) after previous LSG are variable. We sought to determine the weight-loss outcomes of patients undergoing LRYGB after LSG in the largest bariatric surgical network in Canada and to determine whether outcomes differ according to indications for conversion.
The Bariatric Registry is a multi-center database with prospectively collected standardized data on patients undergoing bariatric surgery at ten Bariatric Centers of Excellence within the Ontario Bariatric Network in Ontario, Canada. A retrospective analysis was performed of patients who underwent LRYGB after previous LSG between 2012 and 2019. Weight loss outcomes were compared between patients who underwent LRYGB for insufficient weight loss/weight regain and those who underwent conversion to LRYGB for other reasons.
Excluding patients with multiple revisions and those without follow-up data, 48 patients were included in the analysis: 33 patients (69%) underwent conversion to LRGYB for insufficient weight loss/weight regain (Group 1) and 15 patients (31%) underwent conversion for other reasons (Group 2). Mean body mass index (BMI) measured pre-LSG, pre-LRYGB, and at mid-term follow-up after LRYGB was 61, 48, and 43 kg/m in Group 1 and 51, 39, and 34 kg/m in Group 2, respectively. ΔBMI and %total weight loss (TWL) at mid-term follow-up were not significantly different between the groups.
Conversion to LRYGB after previous LSG resulted in an additional loss of 4 kg/m in BMI points at mid-term follow-up. Patients lost a similar number of BMI points and cumulative %TWL was similar regardless of reason for conversion. This can help inform surgical decision-making in the setting of weight regain after LSG.
尽管腹腔镜袖状胃切除术（LSG）术后报告的效果良好，但仍有一定比例的患者需要接受二次减肥手术，以处理LSG后的副作用或解决体重反弹问题。先前接受过LSG的患者接受腹腔镜Roux-en-Y胃旁路术（LRYGB）后的体重减轻结果存在差异。我们试图确定在加拿大最大的减肥手术网络中，接受过LSG的患者接受LRYGB后的体重减轻结果，并确定结果是否因转换指征而异。
减肥手术登记处是一个多中心数据库，前瞻性收集了加拿大安大略省减肥手术网络内十个卓越减肥中心接受减肥手术患者的标准化数据。对2012年至2019年间先前接受过LSG后又接受LRYGB的患者进行了回顾性分析。比较了因体重减轻不足/体重反弹而接受LRYGB的患者与因其他原因转换为LRYGB的患者的体重减轻结果。
排除多次翻修的患者和无随访数据的患者后，48例患者纳入分析：33例患者（69%）因体重减轻不足/体重反弹而转换为LRGYB（第1组），15例患者（31%）因其他原因转换（第2组）。第1组在LSG前、LRYGB前以及LRYGB术后中期随访时测得的平均体重指数（BMI）分别为61、48和43kg/m²，第2组分别为51、39和34kg/m²。两组在中期随访时的BMI变化值（ΔBMI）和总体重减轻百分比（%TWL）无显著差异。
先前接受LSG后转换为LRYGB在中期随访时导致BMI额外降低4kg/m²。无论转换原因如何，患者BMI降低的点数相似，累积%TWL也相似。这有助于为LSG后体重反弹情况下的手术决策提供参考。
