Department of Surgery, Aleris Obesity Clinic, Aleris Hospital, Oslo, Norway.
Metabolic and Bariatric Unit, GB Obesitas, Skeppsbron 11, 211 20, Malmö, Sweden.
Obes Surg. 2023 Jan;33(1):293-302. doi: 10.1007/s11695-022-06388-z. Epub 2022 Dec 2.
Weight loss failure or weight regain may occur after Roux-en-Y gastric bypass (RYGB). Revisional surgery includes distalization. However, few studies have looked at the associations between the total alimentary limb length (TALL) and weight loss outcomes, none with long-term results.
Peri- and postoperative outcomes were assessed after employing TALL of either 250 cm or 300 cm in the failed RYGB.
This study is a retrospective cohort analysis of 90 patients that underwent laparoscopic distalization between January 2006 and January 2016 due to failed RYBG. The index RYGB was modified to TALL of 250 cm (n = 48) or of 300 cm (n = 42) which entailed elongating the bilio-pancreatic limb (BPL) and transposing the Roux limb (RL) to a common limb (CL) of 100 cm and 150 cm, respectively. Long-term weight loss outcomes along with nutritional and vitamin status were analyzed.
Preoperative BMI at distalization was 38.6 kg/m. After 8 years, excess weight loss (EWL) was 61.8%. No differences between the two groups were seen in weight loss outcomes or early surgical complication rates (6.7%). However, more vitamin and nutritional deficiencies were present in the TALL 250-cm group (50.0% and 35.4%, respectively) versus the TALL 300-cm group (33.3% and 14.3% respectively), which led to laparoscopic revision in 27 patients by lengthening the TALL with 100 cm. Patients with weight regain after index RYGB had in average 59.9% higher EWL than patients with EWL failure.
Distalization of the failed RYGBP is safe and effective, but TALL should not be shorter than 300 cm (and CL 150 cm) due to high rates of malnutrition. Adequate supplementation and long-term follow-up are mandatory to prevent serious malnutrition.
胃旁路手术后（RYGB）可能会出现减肥失败或体重反弹。修正手术包括远侧化。然而，很少有研究关注总肠旁路长度（TALL）与减肥效果之间的关系，更没有研究关注长期结果。
评估在 RYGB 失败后采用 250cm 或 300cm 的 TALL 进行远侧化的围手术期和术后结果。
这是一项回顾性队列分析，纳入了 90 例因 RYGB 失败而在 2006 年 1 月至 2016 年 1 月期间接受腹腔镜下远侧化的患者。指数 RYGB 被修改为 250cm（n=48）或 300cm（n=42）的 TALL，这涉及延长胆胰支（BPL）并将 Roux 支（RL）转移到 100cm 和 150cm 的共同支（CL）。分析长期减肥效果以及营养和维生素状况。
远侧化时的术前 BMI 为 38.6kg/m²。8 年后，多余体重减轻（EWL）为 61.8%。两组在减肥效果或早期手术并发症率（6.7%）方面无差异。然而，TALL 250cm 组的维生素和营养缺乏更为常见（分别为 50.0%和 35.4%），而 TALL 300cm 组的维生素和营养缺乏更为少见（分别为 33.3%和 14.3%），这导致 27 例患者通过将 TALL 延长 100cm 进行腹腔镜修正。与 EWL 失败的患者相比，指数 RYGB 后体重增加的患者的 EWL 平均高出 59.9%。
RYGBP 失败后的远侧化是安全有效的，但由于营养不良发生率较高，TALL 不应短于 300cm（和 CL 150cm）。为了防止严重的营养不良，必须进行充分的补充和长期随访。
