Cuva Dylan, Parikh Manish, Brown Avery, Somoza Eduardo, Saunders John K, Park Julia, Lipman Jeffrey, Einersen Peter, Chui Patricia
Department of Surgery, New York University Langone Medical Center/Bellevue Hospital Center, New York University School of Medicine, 550 1st Ave., New York, NY, 10016, USA.
Surg Endosc. 2025 Feb;39(2):1050-1055. doi: 10.1007/s00464-024-11460-z. Epub 2024 Dec 16.
Conversion from sleeve gastrectomy (SG) to Roux-en-Y gastric bypass (RYGB) may be indicated for patients due to insufficient weight loss or weight regain.
To assess weight loss outcomes and factors predictive of improved weight loss in patients undergoing RYGB after SG and create an algorithm to estimate postoperative weight loss in these patients.
University Hospital.
Retrospective review of patients who underwent conversion from SG to RYGB from 2015 to 2022 was performed, assessing pre-and post-operative weights for each procedure.
114 patients were included (84% female, pre-SG BMI 49.3 ± 10.2). Post-SG, patients achieved a maximum %TBWL of 31.2% ([6.6-58.2] ± 10.1%), %EWL of 56.8%([13.3-97.3] ± 16.4%), and total body weight regain of 53.9%([0.0-144.4] ± 31.3%). Conversion to RYGB resulted in peak %TBWL of 18.8% at 8 months, leveling off at 13.5% thereafter. Factors predictive of greater weight loss post-conversion included higher BMI at time of SG (each 5 kg/m increase yielded 0.8% greater %TBWL [95% CI 0.5-1%, p < 0.0001]) and peak %EWL ≥ 40% after SG (yielding 5.5% more %TBWL, 95%CI 3.9-7.1%, p < 0.0001). Conversely, those who had ≥ 20% weight regain after SG had 4.1% less %TBWL (95%CI 2.5-5.7%, p < 0.0001) after conversion. These factors were used to create BE-CALM, an algorithm to predict %TBWL one year after conversion to RYGB.
Conversion from SG to RYGB is effective for further weight loss. Patients who have higher starting BMI, ≥ 40% %EWL or ≤ 20% weight regain after SG demonstrate the most effective weight loss post-conversion.
由于体重减轻不足或体重反弹，对于一些患者而言，可能需要将袖状胃切除术（SG）转换为Roux-en-Y胃旁路术（RYGB）。
评估SG术后接受RYGB的患者的体重减轻结果以及预测体重减轻改善情况的因素，并创建一种算法来估计这些患者的术后体重减轻情况。
大学医院。
对2015年至2022年期间接受从SG转换为RYGB手术的患者进行回顾性研究，评估每种手术前后的体重。
共纳入114例患者（84%为女性，SG术前体重指数49.3±10.2）。SG术后，患者的最大总体重减轻百分比（%TBWL）达到31.2%（[6.6 - 58.2]±10.1%），多余体重减轻百分比（%EWL）为56.8%（[13.3 - 97.3]±16.4%），总体重反弹为53.9%（[0.0 - 144.4]±31.3%）。转换为RYGB后，8个月时的峰值%TBWL为18.8%，此后稳定在13.5%。转换后体重减轻更多的预测因素包括SG时较高的体重指数（每增加5kg/m²，%TBWL增加0.8%[95%置信区间0.5 - 1%，p < 0.0001]）以及SG术后峰值%EWL≥40%（%TBWL增加5.5%，95%置信区间3.9 - 7.1%，p < 0.0001）。相反，SG术后体重反弹≥20%的患者转换后%TBWL降低4.1%（95%置信区间2.5 - 5.7%，p < 0.0001）。利用这些因素创建了BE-CALM算法，用于预测转换为RYGB一年后的%TBWL。
从SG转换为RYGB对于进一步减轻体重是有效的。SG时起始体重指数较高、SG术后%EWL≥40%或体重反弹≤20%的患者在转换后体重减轻最为有效。
