Miles Bryan, Visioni Anthony, Daigle Christopher, Marley Robert, Brandstetter Stephen
Department of Surgery, Cleveland Clinic Akron General, Akron, OH, United States.
Department of Surgery, Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States.
Front Surg. 2023 Oct 6;10:1249441. doi: 10.3389/fsurg.2023.1249441. eCollection 2023.
Like all surgical fields, bariatric surgery has evolved immensely, so much so that previous procedures are now obsolete. For instance, the jejunoileal bypass has fallen out of favor after severe metabolic consequences resulted in prolonged morbidity and even mortality. Despite this, several patients persevered long enough to develop other pathology, such as cancer. This progression has been validated in animal models but not human patients. Nonetheless, contemporary surgeons may encounter situations where they must resect and re-establish intestinal continuity in patients with this antiquated anatomy. When faced with this scenario, the question of whether or not the previously bypassed small bowel can be safely reunited plagues the surgeon remains unanswered. Unfortunately, the literature does not effectively answer this question, even anecdotally through case reports or series. Therefore, we share our experience with three patients who developed colon cancer following jejunoileal bypass and subsequently underwent oncologic resection with simultaneous reversal of their jejunoileal bypasses.
与所有外科领域一样，减肥手术已经有了巨大的发展，以至于以前的手术方法现在已经过时。例如，空肠回肠分流术在导致长期发病甚至死亡的严重代谢后果后已不再受欢迎。尽管如此，仍有一些患者坚持了足够长的时间，从而发展出其他病理状况，如癌症。这种进展在动物模型中得到了验证，但在人类患者中尚未得到验证。尽管如此，当代外科医生可能会遇到这样的情况，即他们必须在具有这种陈旧解剖结构的患者中进行切除并重新建立肠道连续性。面对这种情况，之前绕过的小肠能否安全重新连接的问题一直困扰着外科医生，目前尚无答案。不幸的是，文献中甚至通过病例报告或系列研究都没有有效地回答这个问题。因此，我们分享我们对三名空肠回肠分流术后发生结肠癌，随后接受肿瘤切除并同时逆转空肠回肠分流术的患者的治疗经验。
