Suppr超能文献

胃旁路手术(OAGB)转为 Roux-en-Y 胃旁路手术(RYGB)治疗胃食管反流病(GERD):谁的风险更高?一项多中心研究。

Conversion of one-anastomosis gastric bypass (OAGB) to Roux-en-Y gastric bypass (RYGB) for gastroesophageal reflux disease (GERD): who is more at risk? A multicenter study.

机构信息

ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité (CCO), 4, place du 4 septembre, 83100, Toulon, France.

Department of Digestive and Bariatric Surgery, Clinica Madonna della Salute, 45014, Porto Viro, Italy.

出版信息

Surg Endosc. 2024 Mar;38(3):1163-1169. doi: 10.1007/s00464-023-10611-y. Epub 2023 Dec 11.

Abstract

BACKGROUND

Although gastroesophageal reflux disease (GERD) affects 0.6% to 10% of patients operated on for one-anastomosis gastric bypass (OAGB), only about 1% require surgery to convert to Roux-en-Y gastric bypass (RYGB) [3-5]. The aim of the present study was to analyze the characteristics of OAGB patients converted to RYGB for GERD not responding to medical treatment.

METHODS

This retrospective multicenter study included patients who underwent conversion from OAGB to RYGB for severe GERD. The conversion was performed with resection of the previous gastro-jejunal anastomosis and the use of the afferent loop as a new biliary loop.

RESULTS

A total of 126 patients were included in the study. Of these patients, 66 (52.6%) had a past medical history of bariatric restrictive surgery (gastric banding, sleeve gastrectomy). A hiatal hernia (HH) was present in 56 patients (44.7%). The association between previous restrictive surgery and HH was recorded in 33 (26.2%) patients. Three-dimensional gastric computed tomography showed an average gastric pouch volume of 242.4 ± 55.1 cm. Conversion to RYGB was performed on average 60 ± 35.6 months after OAGB. Seven patients (5.5%) experienced an early postoperative complication (4 patients grade IIIb and 3 grade IIb), and 3 (2.4%) a late complication. Patients showed further weight loss after RYGB conversion and an average of 24.8 ± 21.7 months after surgery, with a mean % of total weight loss (%TWL) of 6.9 ± 13.6 kg. From a clinical point of view, the problem of GERD was definitively solved in more than 90% of patients.

CONCLUSIONS

Situations that weaken the esogastric junction appear to be highly frequent in patients operated on for OAGB and converted to RYGB for severe reflux. Similarly, the correct creation of the gastric pouch could play an important role in reducing the risk of conversion to RYGB for GERD.

摘要

背景

尽管胃食管反流病(GERD)影响了接受单吻合胃旁路术(OAGB)的患者的 0.6%至 10%,但只有约 1%的患者需要手术转为 Roux-en-Y 胃旁路术(RYGB)[3-5]。本研究的目的是分析对药物治疗无反应的 OAGB 患者转为 RYGB 治疗 GERD 的特征。

方法

这是一项回顾性多中心研究,纳入了因严重 GERD 而接受 OAGB 转为 RYGB 的患者。转换时切除先前的胃空肠吻合口,并使用输入袢作为新的胆支。

结果

共有 126 例患者纳入本研究。其中,66 例(52.6%)有减重限制性手术(胃束带、袖状胃切除术)的既往病史。56 例(44.7%)存在食管裂孔疝(HH)。33 例(26.2%)患者存在既往限制性手术与 HH 的相关性。三维胃计算机断层扫描显示平均胃袋容积为 242.4±55.1cm³。OAGB 后平均 60±35.6 个月行 RYGB 转换。7 例(5.5%)患者发生早期术后并发症(4 例为 IIIb 级,3 例为 IIb 级),3 例(2.4%)发生晚期并发症。患者在 RYGB 转换后进一步减重,平均术后 24.8±21.7 个月,体重总丢失率(%TWL)平均为 6.9±13.6kg。从临床角度来看,超过 90%的患者 GERD 问题得到了明确解决。

结论

在接受 OAGB 手术并因严重反流转为 RYGB 的患者中,似乎存在胃食管连接减弱的情况。同样,胃袋的正确创建可能在降低 GERD 转为 RYGB 的风险方面发挥重要作用。

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验