Management of Complications and Outcomes After Revisional Bariatric Surgery: 3-Year Experience at a Bariatric Center of Excellence
Management of Complications and Outcomes After Revisional Bariatric Surgery: 3-Year Experience at a Bariatric Center of Excellence
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DOI：
10.1007/s11695-016-2071-x
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发表时间：
2016-09-01
期刊：
影响因子：
2.9
通讯作者：
Silecchia, Gianfranco
中科院分区：
文献类型：
--
作者：
Abdelgawad, Mohamed;De Angelis, Francesco;Silecchia, Gianfranco
腹腔镜减肥修正手术（RBS）越来越普遍。提倡量身定制的决策过程。在这项回顾性研究中，我们回顾了单个中心的 RBS 经验，分析了围手术期并发症，以深入了解管理方案和中期结果。从前瞻性维护的数据库中回顾了 2011 年 11 月至 2015 年 3 月的记录。 618 名患者接受了腹腔镜减肥手术；其中，81 例 (13.1%) 接受了 RBS。对至少随访 6 个月的患者 (n = 77) 进行了评估。 59 人接受了改良的腹腔镜袖状胃切除术，18 人接受了改良的 Roux-en-Y 胃绕道术。 RBS 的适应症为 42 例 (54.5%) 体重减轻或体重恢复不足，35 例 (45.5%) 为胃食管反流病 (GERD)、手术相关并发症或技术故障。没有死亡或转为开放手术。平均随访 22 个月后，体重指数 (BMI) 从 40.9 +/- 6.7 下降至 31.9 +/- 4.8 kg/m(2)，平均超重减轻百分比 (%EWL) 为 58 +/- 24.3 %，55.3 % 的患者合并症得到缓解。发生了 8 例主要并发症 (10.4%)：5 例渗漏和 3 例腹内血肿。非手术治疗成功解决了 50% 的并发症。这项研究证实 RBS 具有挑战性；预计并发症发生率为 10%。如果有专门的内窥镜医师和放射科医生在场，就可以避免大手术。并发症发生后的密集随访可以及早诊断和治疗不良后遗症。 RBS 导致 2 年平均 %EWL 为 58%，并解决了 50% 病例的合并症。然而，这些影响的持久性仍然值得怀疑。
Laparoscopic revisional bariatric surgery (RBS) is increasingly common. A tailored decision-making process is advocated. In this retrospective study, we reviewed the RBS experience of a single center, analyzing perioperative complications to provide insight into management options and midterm outcomes.Records from November 2011 to March 2015 were reviewed from prospectively maintained database. Six hundred eighteen patients underwent laparoscopic bariatric procedures; of these, 81 (13.1 %) underwent RBS. Patients with a minimum follow-up of 6 months (n = 77) were evaluated. Fifty-nine underwent revised laparoscopic sleeve gastrectomy, and 18 underwent revised Roux-en-Y gastric bypass. Indications for RBS were inadequate weight loss or weight regain in 42 cases (54.5 %) and gastroesophageal reflux disease (GERD), procedure-related complications, or technical failure in 35 cases (45.5 %).There were no deaths or conversions to open surgery. After a mean follow-up of 22 months, body mass index (BMI) decreased from 40.9 +/- 6.7 to 31.9 +/- 4.8 kg/m(2), mean % excess weight loss (%EWL) was 58 +/- 24.3 %, and 55.3 % of patients had resolution of comorbidities. Eight major complications (10.4 %) occurred: five leaks and three intra-abdominal hematomas. Non-surgical management succeeded in 50 % of complications.This study confirms that RBS is challenging; a complication rate of 10 % is expected. Major surgery can be avoided when devoted endoscopists and radiologists are available. Intensive follow-up after complications allows early diagnosis and treatment of unfavorable sequelae. RBS induced a mean %EWL of 58 % at 2 years and resolution of comorbidities in 50 % of cases. However, the durability of these effects remains questionable.