University Digestive Health Care Center Basel - Clarunis, CH-4002, Basel, Switzerland.
Interdisciplinary Center of Nutritional and Metabolic Diseases, St. Clara Hospital, CH-4058, Basel, Switzerland.
Obes Surg. 2023 Sep;33(9):2679-2686. doi: 10.1007/s11695-023-06734-9. Epub 2023 Jul 29.
In the long term, laparoscopic sleeve gastrectomy (SG) may be associated with insufficient weight loss (IWL), gastroesophageal reflux disease (GERD), and persistence or relapse of associated medical problems. This study's objective is to present mid-term results regarding weight loss (WL), evolution of associated medical problems, and reoperation rate of patients who underwent a conversion after SG.
Retrospective single-center analysis of patients with a minimal follow-up of 2 years after conversion.
In this series of 549 SGs, 84 patients (15.3%) underwent a conversion, and 71 met inclusion criteria. They were converted to short biliopancreatic limb Roux-en-Y gastric bypass (short BPL RYGB) (n = 28, 39.4%), biliopancreatic diversion with duodenal switch (BPD/DS) (n = 19, 26.8%), long biliopancreatic limb Roux-en-Y gastric bypass (long BPL RYGB) (n = 17, 23.9%), and re-sleeve gastrectomy (RSG) (n = 7, 9.9%). Indications were GERD (n = 24, 33.8%), IWL (n = 23, 32.4%), IWL + GERD (n = 22, 31.0%), or stenosis/kinking of the sleeve (n = 2, 2.8%). The mean pre-revisional body mass index (BMI) was 38.0 ± 7.5 kg/m. The mean follow-up time after conversion was 5.1 ± 3.1 years. The overall percentage of total weight loss (%TWL) was greatest after BPD/DS (36.6%) and long BPL RYGB (32.9%) compared to RSG (20.0%; p = 0.004; p = 0.049). In case of GERD, conversion to Roux-en-Y gastric bypass (RYGB) led to a resolution of symptoms in 79.5%. 16.9% of patients underwent an additional revisional procedure.
In the event of IWL after SG, conversion to BPD/DS provides a significant and sustainable additional WL. Conversion to RYGB leads to a reliable symptom control in patients suffering from GERD after SG.
长期来看，腹腔镜袖状胃切除术（LSG）可能与体重减轻不足（IWL）、胃食管反流病（GERD）以及相关医疗问题的持续或复发有关。本研究的目的是报告患者接受 LSG 转换后的中期减重（WL）、相关医疗问题演变和再次手术率的结果。
对接受 LSG 转换且随访时间至少 2 年的患者进行回顾性单中心分析。
在这一系列 549 例 LSG 中，84 例（15.3%）患者进行了转换，71 例符合纳入标准。他们被转换为短胆胰支 Roux-en-Y 胃旁路术（短 BPL RYGB）（n=28，39.4%）、胆胰分流十二指肠转位术（BPD/DS）（n=19，26.8%）、长胆胰支 Roux-en-Y 胃旁路术（长 BPL RYGB）（n=17，23.9%）和再袖状胃切除术（RSG）（n=7，9.9%）。手术指征为胃食管反流病（GERD）（n=24，33.8%）、体重减轻不足（IWL）（n=23，32.4%）、IWL+GERD（n=22，31.0%）或袖状狭窄/扭转（n=2，2.8%）。术前体重指数（BMI）的平均值为 38.0±7.5kg/m。转换后随访时间的平均值为 5.1±3.1 年。与 RSG（20.0%；p=0.004；p=0.049）相比，BPD/DS（36.6%）和长 BPL RYGB（32.9%）的总体体重减轻百分比（%TWL）更高。对于 GERD，胃旁路术（RYGB）转换可使 79.5%的患者症状得到缓解。16.9%的患者接受了额外的再次手术。
在 LSG 后出现 IWL 的情况下，转换为 BPD/DS 可提供显著且可持续的额外 WL。转换为 RYGB 可在 LSG 后患有 GERD 的患者中可靠地控制症状。
