Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Experimental Surgery and Simulation Center, Catholic University of Chile, Santiago, Chile.
Obes Surg. 2024 Jul;34(7):2411-2419. doi: 10.1007/s11695-024-07353-8. Epub 2024 Jun 11.
Vertical banded gastroplasty (VBG) was once the most popular bariatric procedure in the 1980's, with many patients subsequently requiring conversional surgery. However, knowledge regarding the prevalence and outcomes of these procedures remains limited. This study aims to determine the prevalence, indications, rate of 30-day serious complications, and mortality of conversional surgery after VBG.
A retrospective analysis of the MBSAQIP database from 2020 to 2022 was conducted. Individuals undergoing conversional or revisional surgery after VBG were included. The primary outcomes were 30-day serious complications and mortality.
Of 716 VBG conversions, the common procedures included 660 (92.1%) Roux-en-Y gastric bypass (RYGB) and 56 (7.9%) sleeve gastrectomy (SG). The main indication for conversion was weight gain for RYGB (31.0%) and for SG (41.0%). RYGB had longer operative times than SG (223.7 vs 130.5 min, p < 0.001). Although not statistically significant, serious complications were higher after RYGB (14.7% vs 8.9%, p = 0.2). Leak rates were higher after SG (5.4 vs 3.5%) but this was not statistically significant (p = 0.4). Mortality was similar between RYGB and SG (1.2 vs 1.8%, p = 0.7). Multivariable regression showed higher body mass index, longer operative time, previous cardiac surgery and black race were independently associated with serious complications. Conversion to RYGB was not predictive of serious complications compared to SG (OR 0.96, 95%CI 0.34-2.67, p = 0.9).
Conversional surgery after VBG is uncommon, and the rate of complications and mortality remains high. Patients should be thoroughly evaluated and informed about these risks before undergoing conversion from VBG.
垂直束带胃成形术（VBG）曾是 20 世纪 80 年代最流行的减肥手术之一，许多患者随后需要进行转换手术。然而，关于这些手术的流行程度和结果的知识仍然有限。本研究旨在确定 VBG 后转换手术的流行程度、适应证、30 天严重并发症发生率和死亡率。
对 2020 年至 2022 年 MBSAQIP 数据库进行回顾性分析。纳入接受 VBG 后转换或修订手术的个体。主要结局是 30 天的严重并发症和死亡率。
在 716 例 VBG 转换中，常见的手术包括 660 例（92.1%）Roux-en-Y 胃旁路术（RYGB）和 56 例（7.9%）袖状胃切除术（SG）。转换的主要适应证是 RYGB（31.0%）和 SG（41.0%）的体重增加。RYGB 的手术时间长于 SG（223.7 分钟比 130.5 分钟，p<0.001）。虽然没有统计学意义，但 RYGB 的严重并发症发生率较高（14.7%比 8.9%，p=0.2）。SG 的漏率较高（5.4%比 3.5%），但无统计学意义（p=0.4）。RYGB 和 SG 的死亡率相似（1.2%比 1.8%，p=0.7）。多变量回归显示，较高的体重指数、较长的手术时间、既往心脏手术和黑人种族与严重并发症独立相关。与 SG 相比，转换为 RYGB 并不能预测严重并发症（OR 0.96，95%CI 0.34-2.67，p=0.9）。
VBG 后转换手术并不常见，并发症和死亡率仍然很高。在进行 VBG 转换之前，患者应进行全面评估，并告知这些风险。
