Department of General Surgery, AZ Sint Jan Brugge-Oostende AV, Campus Henri Serruys, 8400, Oostende, Belgium.
Department of General Surgery, AZ Sint-Jan Brugge-Oostende AV, Ruddershove 10, 8000, Brugge, Belgium.
Obes Surg. 2023 Oct;33(10):2963-2972. doi: 10.1007/s11695-023-06746-5. Epub 2023 Aug 7.
Laparoscopic adjustable gastric band (LAGB) has high technical and weight loss failure rates. We evaluate here the 1-year morbidity, mortality, and weight loss of laparoscopic Roux-en-Y-gastric bypass (LRYGB) as a feasible conversion strategy.
Patients with a failed primary LAGB who underwent LRYGB from July 2004 to December 2019 were selected from an electronic database at our center. Patients had a conversion to LRYGB at the same time (one-stage approach) or with a minimum of 3 months in between (two-stage approach). Primary outcomes included 30-day morbidity and mortality. Secondary outcomes were body mass index (BMI), percent excess weight loss (%EWL), and percent excess BMI lost (%EBMIL) at 1 year postoperatively.
A total of 1295 patients underwent a conversion from LAGB to LRYGB at our center: 1167 patients (90.1%) in one stage and 128 patients (9.9%) in two stages. There was no mortality. An early (30-day) postoperative complication occurred in 93 patients (7.2%), with no significant difference found between groups. Hemorrhage was the most common complication in 39 patients (3.0%), and the reoperation was required in 19 patients (1.4%). At 1 year postoperatively, the mean BMI was 28.0 kg/m, the mean %EWL 72.8%, and the mean %EBMIL 87.0%. No statistically significant difference was found between the groups.
Conversion to LRYGB can be considered as a safe and effective option with low complication rate and good weight loss outcomes at 1 year. One-stage conversion provides the same early outcome as two-step surgery with a competent surgeon.
腹腔镜可调节胃束带术（LAGB）的技术和减重失败率均较高。我们在此评估腹腔镜 Roux-en-Y 胃旁路术（LRYGB）作为可行的转换策略在一年内的发病率、死亡率和减重效果。
我们从中心电子数据库中选择了 2004 年 7 月至 2019 年 12 月因 LAGB 治疗失败而接受 LRYGB 的患者。患者在同一时间（一期手术）或至少相隔 3 个月（二期手术）进行 LRYGB 转换。主要结局包括 30 天发病率和死亡率。次要结局为术后 1 年的体重指数（BMI）、多余体重减轻百分比（%EWL）和多余 BMI 减轻百分比（%EBMIL）。
共有 1295 例患者在我院行 LAGB 至 LRYGB 转换：1167 例（90.1%）为一期手术，128 例（9.9%）为二期手术。无死亡病例。93 例（7.2%）患者发生早期（30 天）术后并发症，两组间无显著差异。最常见的并发症是 39 例（3.0%）出血，19 例（1.4%）需要再次手术。术后 1 年时，平均 BMI 为 28.0kg/m，平均%EWL 为 72.8%，平均%EBMIL 为 87.0%。两组间无统计学差异。
对于 LAGB 治疗失败的患者，转换为 LRYGB 是一种安全有效的选择，并发症发生率低，术后 1 年的减重效果良好。对于经验丰富的外科医生来说，一期转换与两步手术具有相同的早期结果。
