Sugerman H J, Kellum J M, DeMaria E J, Reines H D
Department of Surgery, Virginia Commonwealth University, Richmond, USA.
Am J Surg. 1996 Feb;171(2):263-9. doi: 10.1016/S0002-9610(97)89565-7.
Previous studies have documented a significantly better we weight loss for gastric bypass (GBP) than for vertical banded gastroplasty (VGB). Additional problems associated with VBG include intractable vomiting or gastroesophageal (GE) reflux, intragastric migration of the polypropylene band, staple line disruption, or inadequate weight loss due to excessive ingestion of high-calorie liquid or soft carbohydrates.
Fifty-eight morbidly obese patients underwent conversion from VBG to GBP for either weight-loss failure (15) or complications of VBG (43), including 2 who where referred with anastomotic leaks and peritonitis, 3 with band erosion, 15 with staple line disruption, and 23 with stomal stenosis, of whom 6 had severe GE reflux, with a Barrett's esophagus in 1.
Percentage of excess weight loss in the 53 patients followed up for at least 1 year after conversion increased from 36% +/- 24% to 67% +/- 18%, and in the 15 "sweets eaters" from 20% +/- 19% to 70% +/- 19% (both P <0.001), was equal to weight loss after primary GBP, and was reasonably constant over 8 years in those patients who could be contacted for follow-up, although average follow-up after 5 years was only 45% All patients had resolution of GE reflux symptoms immediately after surgery and for at least 1 year or at last contact. Complications of conversion included 2 anastomotic leaks with major wound infections (1 in a referred patient requiring emergency subtotal gastrectomy following a VBG leak), 3 staple line disruptions (2 subclinical), 3 small-bowel obstructions, and 20 marginal ulcers or stomal stenoses (all responded to endoscopic balloon dilation or acid reduction therapy). Hemoglobin, calcium, and vitamin B12 levels remained within normal levels with prophylactic supplementation in patients who returned for follow-up evaluation.
These data support the efficacy of conversion to GBP in morbidly obese patients with a failed or complicated VBG.
既往研究表明，胃旁路术（GBP）导致的体重减轻效果显著优于垂直束带胃成形术（VGB）。与VGB相关的其他问题包括顽固性呕吐或胃食管（GE）反流、聚丙烯束带在胃内移位、吻合钉线裂开，或因过量摄入高热量液体或软质碳水化合物导致体重减轻不足。
58例病态肥胖患者因减肥失败（15例）或VGB并发症（43例）接受了从VGB转换为GBP的手术，其中2例因吻合口漏和腹膜炎转诊，3例因束带侵蚀，15例因吻合钉线裂开，23例因吻合口狭窄，其中6例有严重的GE反流，1例有巴雷特食管。
53例患者在转换手术后至少随访1年，其超重体重减轻百分比从36%±24%增至67%±18%，15例“嗜甜食者”从20%±19%增至70%±19%（均P<0.001），与初次GBP后的体重减轻效果相当，在可联系到进行随访的患者中，8年期间体重减轻情况相当稳定，尽管5年后的平均随访率仅为45%。所有患者术后立即且至少在1年或最后一次随访时GE反流症状均得到缓解。转换手术的并发症包括2例吻合口漏伴严重伤口感染（1例转诊患者在VGB漏后需要急诊次全胃切除术）、3例吻合钉线裂开（2例亚临床）、3例小肠梗阻，以及20例边缘溃疡或吻合口狭窄（均对内镜球囊扩张或抑酸治疗有反应）。接受随访评估的患者经预防性补充后，血红蛋白、钙和维生素B12水平保持在正常范围内。
这些数据支持了将VGB失败或出现并发症的病态肥胖患者转换为GBP的有效性。
