Athanasiadis Dimitrios I, Giannopoulos Spyridon, Selzer Don, Stefanidis Dimitrios
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Section of Minimally Invasive and Bariatric Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Surg Endosc. 2024 Dec;38(12):7486-7490. doi: 10.1007/s00464-024-11188-w. Epub 2024 Sep 12.
Weight recurrence (WR) affects > 20% of patients following Roux-en-Y gastric bypass (RYGB). Shortening of the common channel (CC) after RYGB (distal bypass) has been proposed for additional weight loss in patients with WR, but results vary, and concerns for vitamin deficiencies/malnutrition exist. Our aim was to determine whether the percentage of bowel bypassed after distal bypass is associated with the amount of postoperative weight loss.
Patients undergoing distal bypass between 2018 and 2022 were reviewed. Small bowel limb lengths before and after distal bypass were measured, and the percentage of bypassed bowel was calculated (= bypassed biliopancreatic limb/total small bowel length). Patients were dichotomized into two groups based on the percentage bypassed bowel (≤ 50% vs. > 50%). Weight loss (measured as excess BMI loss; EBIL%), comorbidities resolution, complications, and nutritional deficiencies were reviewed.
Thirty female patients underwent distal bypass during the study period. After distal bypass, the Roux was lengthened to 150 cm (75-175 cm) from 75 cm (20-200 cm), and the CC shortened to 150 cm (100-310 cm) from 510 cm (250-1000 cm). These changes resulted in an increase in the size of the bypassed biliopancreatic limb from 40 cm (15-90 cm) to 330 cm (180-765 cm) and a total alimentary limb (TALL; Roux + CC) shortening from 590 cm (400-1075 cm) to 300 cm (250-400 cm). The group with > 50% bowel bypassed had higher EBIL%. Overall EBIL% was 36.9 ± 14.7%, 53.3 ± 25.6%, and 62.1 ± 36.9% at 0.5, 1, and 2 years, respectively. There were minimal vitamin deficiencies. Diabetes resolved in 100% (n = 3/3), HTN in 67% (n = 10/15), and GERD in 73% (n = 11/15). Complication rate was 23%. No reintervention for malnutrition or vitamin deficiencies was required.
Distal bypass effectively leads to considerable weight loss and comorbidity improvement in patients with WR after RYGB, but the amount of weight loss depends on the percentage of bypassed bowel. An exact threshold of bypassed bowel that optimizes weight loss outcomes and simultaneously minimizes the nutritional complications needs to be determined. Meanwhile, close monitoring for vitamin deficiencies is recommended.
体重复发（WR）影响超过20%的接受Roux-en-Y胃旁路术（RYGB）的患者。有人提出在RYGB术后缩短共同通道（CC）（远端旁路术）可使WR患者进一步减重，但结果各异，且存在维生素缺乏/营养不良的问题。我们的目的是确定远端旁路术后绕过肠段的百分比是否与术后体重减轻量相关。
回顾了2018年至2022年间接受远端旁路术的患者。测量了远端旁路术前和术后的小肠肠袢长度，并计算绕过肠段的百分比（=绕过的胆胰肠袢/小肠总长度）。根据绕过肠段的百分比将患者分为两组（≤50%与>50%）。回顾了体重减轻情况（以超重BMI减轻量衡量；EBIL%）、合并症缓解情况、并发症及营养缺乏情况。
在研究期间，30名女性患者接受了远端旁路术。远端旁路术后，Roux肠袢从75 cm（20 - 200 cm）延长至150 cm（75 - 175 cm），CC从510 cm（250 - 1000 cm）缩短至150 cm（100 - 310 cm）。这些变化导致绕过的胆胰肠袢长度从40 cm（15 - 90 cm）增加至330 cm（180 - 765 cm），总消化道肠袢（TALL；Roux + CC）从590 cm（400 - 1075 cm）缩短至300 cm（250 - 400 cm）。绕过肠段>50%的组EBIL%更高。总体EBIL%在0.5年、1年和2年时分别为36.9±14.7%、53.3±25.6%和62.1±36.9%。维生素缺乏情况极少。糖尿病缓解率为100%（n = 3/3），高血压为67%（n = 10/15），胃食管反流病为73%（n = 11/15）。并发症发生率为23%。无需因营养不良或维生素缺乏进行再次干预。
远端旁路术可有效使RYGB术后WR患者实现显著体重减轻并改善合并症，但体重减轻量取决于绕过肠段的百分比。需要确定能优化体重减轻效果并同时将营养并发症降至最低的绕过肠段的确切阈值。同时，建议密切监测维生素缺乏情况。
