Cornejo Jorge, Pontecorvo Agustina A, Badurdeen Dilhana, Gomez Victoria, Kumbhari Vivek, Elli Enrique F
Department of General Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
Division of Gastroenterology, Mayo Clinic, Jacksonville, FL, USA.
Surg Endosc. 2025 Jun 13. doi: 10.1007/s00464-025-11846-7.
There are numerous revisional surgery options for weight loss failure after Roux-en-Y Gastric Bypass. To date, there are no studies that assess the weight loss outcomes of single-stage endoscopic revision of the gastrojejunostomy (GJ) (TORe) in biliopancreatic (BP) limb distalization. We aimed to report our experience with single-stage TORe and distalization.
Sixteen patients (5 TORe and distalization, 6 TORe alone, 5 distalization alone) from 2021 to 2023 were included and retrospectively reviewed. The minimum follow-up time was 24 months. The alimentary limb was distalized to allow for a total common channel length of about 150 cm and the endoscopic suturing was used to bring the diameter of the GJ between 10 and 20 mm.
The average preoperative BMI was 44.25 ± 8.8 kg/m with an average excess body weight of 54.16 ± 23.6 kg. The mean operative time for patients who had distalization with and without TORe was 128.4 ± 30.3 min. The mean total alimentary limb length (TALL) was 300 + 45.6 cm. Single-stage TORe and distalization showed higher mean %TWL (23.67 vs 19.92 vs 15.02) and %EWL (37.20 vs 30.72 vs 27) compared to TORe and distalization alone at 24-month follow-up, respectively. One patient required distalization reversal due to malnutrition. The rest of patients who underwent distalization showed minor nutritional deficiencies (Hemoglobin, Hematocrit, Vitamin A, and Copper) at the last follow-up. Preoperative comorbidities were reduced by 33.2%.
Endoscopic and surgical techniques for the management of weight loss failure after Roux-en-Y Gastric Bypass seem to be safe and effective. Single-stage TORe and distalization showed higher weight loss at 24-month follow-up.
对于Roux-en-Y胃旁路术后减肥失败有多种翻修手术选择。迄今为止，尚无研究评估胆胰（BP）支远端化的胃空肠吻合术（GJ）单阶段内镜翻修术（TORe）的减肥效果。我们旨在报告我们单阶段TORe和远端化的经验。
纳入2021年至2023年的16例患者（5例TORe联合远端化、6例单纯TORe、5例单纯远端化）并进行回顾性分析。最短随访时间为24个月。将消化道支远端化以使总共同通道长度约为150 cm，并使用内镜缝合使GJ直径在10至20 mm之间。
术前平均体重指数（BMI）为44.25±8.8 kg/m²，平均超重54.16±23.6 kg。进行远端化（无论是否联合TORe）的患者平均手术时间为128.4±30.3分钟。平均消化道支总长度（TALL）为300 + 45.6 cm。在24个月随访时，单阶段TORe联合远端化与单纯TORe和单纯远端化相比，分别显示出更高的平均体重减轻百分比（%TWL）（23.67对19.92对15.02）和超重减轻百分比（%EWL）（37.20对30.72对27）。1例患者因营养不良需要逆转远端化。其余接受远端化的患者在最后随访时显示有轻微营养缺乏（血红蛋白、血细胞比容、维生素A和铜）。术前合并症减少了33.2%。
Roux-en-Y胃旁路术后减肥失败的内镜和手术治疗技术似乎安全有效。单阶段TORe联合远端化在24个月随访时显示出更高程度的体重减轻。
