单吻合口手术作为胃旁路术后体重反弹的翻修手术的 5 年疗效和结局的对比分析。

Comparative analysis of 5-year efficacy and outcomes of single anastomosis procedures as revisional surgery for weight regain following sleeve gastrectomy.

机构信息

Bariatric and Metabolic Surgery Department, Hamad General Hospital (HGH), Hamad Medical Corporation (HMC), Doha, Qatar.

Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar.

出版信息

Surg Endosc. 2023 Oct;37(10):7548-7555. doi: 10.1007/s00464-023-10234-3. Epub 2023 Jul 11.

DOI:10.1007/s00464-023-10234-3

PMID:37432485

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10520093/

Abstract

BACKGROUND

It is imperative to assess the results of revisional procedures following Sleeve Gastrectomy (SG), given the substantially growing population of patients who experience weight regain within a few years after undergoing this procedure.

OBJECTIVE

Examine the comparative effectiveness of the Single Anastomosis Duodeno-Ileal Bypass (SADI-S) and the One Anastomosis Gastric Bypass (OAGB-MGB) as revisional procedures, with respect to their impact on weight loss, resolution of comorbidities, incidence of complications, and rates of reoperation in patients who had weight regain after SG with up to or more than 5 years of follow-up.

SETTING

Hamad General Hospital, Academic tertiary referral center, Qatar.

METHODS

This study retrospectively analyzed a database of patients who underwent the Single Anastomosis Duodeno-Ileal Switch (SADI-S) or the One Anastomosis Gastric Bypass - Mini Gastric Bypass- (OAGB-MGB) as revisional procedures for weight recidivism after a primary Laparoscopic Sleeve Gastrectomy (LSG). The follow-up period was at least 5 years, during which the impact of both procedures on weight loss, comorbidities, nutritional deficiencies, complications, and outcomes were compared.

RESULTS

The study comprised 91 patients, with 42 and 49 in the SADI-S and OAGB-MGB groups, respectively. Significant weight loss (measured by total weight loss percentage, TWL%) was observed at the 5-year follow-up for the SADI-S group compared to the OAGB-MGB group (30.0 ± 18.4 vs. 19.4 ± 16.3, p = 0.008). Remission of comorbidities, specifically diabetes mellitus and hypertension, was more prevalent in the SADI-S group. Notably, the OAGB-MGB group had a higher incidence of complications (28.6% vs. 21.42%) and reoperations (5 patients vs. 1 in the SADI-S group). No mortality events were reported in either group.

CONCLUSION

While both the OAGB-MGB and SADI-S have demonstrated efficacy as revisional procedures for weight regain following SG, the SADI-S exhibits superior outcomes compared to the OAGB-MGB with regard to weight loss, resolution of comorbidities, complication rates, and reoperation rates.

摘要

背景

鉴于接受袖状胃切除术（SG）后几年内体重反弹的患者数量大幅增加，评估胃旁路术（SG）后的翻修手术结果势在必行。

目的

检查单吻合十二指肠空肠旁路术（SADI-S）和单吻合胃旁路术-迷你胃旁路术（OAGB-MGB）作为翻修术的比较效果，这些术式对体重减轻、并发症发生率和再手术率的影响，这些术式适用于接受 SG 后体重反弹的患者，且随访时间至少为 5 年。

设置

卡塔尔哈马德综合医院，学术三级转诊中心。

方法

这项研究回顾性分析了数据库中的患者，这些患者接受了单吻合十二指肠空肠旁路术（SADI-S）或单吻合胃旁路术-迷你胃旁路术（OAGB-MGB）作为腹腔镜袖状胃切除术（LSG）后体重反弹的翻修术。随访时间至少为 5 年，在此期间比较了两种手术对体重减轻、合并症、营养缺乏、并发症和结果的影响。

结果

该研究纳入了 91 名患者，其中 SADI-S 组和 OAGB-MGB 组分别为 42 名和 49 名。与 OAGB-MGB 组相比，SADI-S 组在 5 年随访时的体重减轻量显著（通过总体重减轻百分比 TWL% 衡量）（30.0 ± 18.4% vs. 19.4 ± 16.3%，p = 0.008）。SADI-S 组糖尿病和高血压等合并症的缓解率更高。值得注意的是，OAGB-MGB 组的并发症发生率（28.6% vs. 21.42%）和再手术率（5 例 vs. SADI-S 组 1 例）更高。两组均未发生死亡事件。