Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland.
Department of General Medicine and Gerontocardiology, Centre of Postgraduate Medical Education, Orłowski Hospital, Czerniakowska 231, 00-416, Warsaw, Poland.
Updates Surg. 2024 Oct;76(6):2267-2275. doi: 10.1007/s13304-024-01820-8. Epub 2024 Apr 9.
The study aimed to evaluate the mid-term weight loss outcomes and complications of revisional one-anastomosis gastric bypass (OAGB) following failed laparoscopic sleeve gastrectomy (LSG). A total of 586 patients underwent LSG from January 2010 to February 2018. Revisional OAGB (rOAGB) was performed in 22 (3.8%) patients. A retrospective analysis of prospectively collected data from 20 patients with at least 12 months of follow-up after the revisional OAGB was carried out. The indications for revisional surgery were as follows: insufficient weight loss-4 (20%), weight regain-13 (65%), weight regain and symptoms of gastroesophageal reflux disease (GERD)-2 (10%), and dysphagia with gastroesophageal reflux-1 (5%). The mean interval between the LSG and rOAGB was 35.3 ± 15.4 months (range 4-64). The mean follow-up time after rOAGB was 45.5 ± 17.1 months (range 12-54). At the end of the follow-up after rOAGB, %TWL was 26.4 ± 8.9%, and %EWL was 58.5 ± 21.6%, based on pre-LSG body weight. In all three patients with intractable GERD, the clinical symptoms of reflux retreated after revisional OAGB. The overall complication rate was 20%. In conclusion, the main indications for revision after LSG are weight regain, insufficient weight loss, and intractable GERD. Revisional OAGB emerges as a viable surgical alternative for unsuccessful LSG, presenting notable weight loss outcomes; however, it may be linked to an increased incidence of complications.
本研究旨在评估腹腔镜袖状胃切除术（LSG）失败后再次行单吻合口胃旁路术（OAGB）的中期减重效果和并发症。2010 年 1 月至 2018 年 2 月，共有 586 例患者接受 LSG。22 例（3.8%）患者行再次 OAGB（rOAGB）。对 20 例至少随访 12 个月的患者进行了前瞻性数据回顾性分析。再次手术的指征如下：减重不足-4 例（20%）、体重反弹-13 例（65%）、体重反弹和胃食管反流病（GERD）症状-2 例（10%）、胃食管反流伴吞咽困难-1 例（5%）。LSG 和 rOAGB 之间的平均间隔时间为 35.3±15.4 个月（范围 4-64）。rOAGB 后的平均随访时间为 45.5±17.1 个月（范围 12-54）。rOAGB 后随访结束时，%TWL 为 26.4±8.9%，%EWL 为 58.5±21.6%，以术前 LSG 体重为基准。在所有 3 例难治性 GERD 患者中，反流的临床症状在再次 OAGB 后均得到缓解。总的并发症发生率为 20%。总之，LSG 后再次手术的主要指征是体重反弹、减重不足和难治性 GERD。再次 OAGB 作为 LSG 失败的一种可行的手术选择，可获得显著的减重效果，但可能与并发症发生率增加有关。
