Medium-Term Results of Combined Laparoscopic Sleeve Gastrectomy and Modified Jejuno-Ileal Bypass in Bariatric Surgery
Medium-Term Results of Combined Laparoscopic Sleeve Gastrectomy and Modified Jejuno-Ileal Bypass in Bariatric Surgery
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DOI：
10.1007/s11695-016-2098-z
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发表时间：
2016-02
期刊：
影响因子：
2.9
通讯作者：
A. Hassn;A. Luhmann;S. Rahmani;G. Morris-Stiff
中科院分区：
文献类型：
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作者：
A. Hassn;A. Luhmann;S. Rahmani;G. Morris-Stiff
研究背景理想的减肥手术可达到70- 100%的维持性多余体重减轻，操作简单，手术风险低，并能维持微量元素的吸收。我们的目的是找到一个减肥的程序，实现上述目标，同时避免目前的选项的缺点。MethodsA标准袖状胃切除术与改良的空回肠旁路分开的小肠75厘米远的十二指肠空肠曲，aerosing它的回肠75厘米近端回盲瓣。前瞻性收集2004年12月至2013年1月期间的手术和随访数据。结果分析了168例手术（110例女性，58例男性）。患者平均年龄为43岁（IQR 37-47），中位术前体重指数（kg/m2）为52（IQR 49-59）。所有手术均在腹腔镜下完成。体重过度减轻分别为78%（IQR 70- 83%，12个月，n= 168）、79%（IQR 70- 85%，24个月），在最近随访时保持77%（IQR 68- 84%，n= 168），仅8年随访时保持75%（IQR 66- 84%，n= 18）。无手术死亡，并发症发生率为5.4%. 6.5%的患者出现一过性呕吐。未观察到倾倒或细菌过度生长的症状。所有人都有正常的肝酶。低钙血症（20.8%）和锌缺乏（25.6%）通过口服补充剂解决。2型糖尿病解决在80.3%，其余患者的改善，高血压解决在92.3%，并改善在rest. ConclusionsWhile目前的调查程序，并在研究的局限性相结合的袖状胃切除术与改良空回肠旁路是安全和有效的，并避免了许多问题与当前的减肥手术，同时提供保持多余的体重减轻。
BackgroundThe ideal bariatric operation achieves 70–100 % maintained excess weight loss, is simple with low operative risks, and maintains absorption of trace elements. Our aim was to find a bariatric procedure that achieves the above while avoiding drawbacks of current options.MethodsA standard sleeve gastrectomy was combined with a modified jejuno-ileal bypass dividing the small bowel 75 cm distal to the duodeno-jejunal flexure, anastomosing it to the ileum 75 cm proximal to the ileocaecal valve. Operative and follow-up data were collected prospectively between December 2004 and January 2013.ResultsOne hundred sixty-eight procedures were analysed (110 female, 58 male). Mean patient age was 43 years (IQR 37–47), and median preoperative body mass index (kg/m2) was 52 (IQR 49–59). All operations were completed laparoscopically. Excess weight loss was 78 % (IQR 70–83 %, 12 months,n= 168), 79 % (IQR 70–85 %, 24 months), maintained at most recent follow-up with 77 % (IQR 68–84 %,n= 168), and for 8 year follow-up alone 75 % (IQR 66–84 %,n= 18). There was no operative mortality and 5.4 % morbidity. A 6.5 % of patients experienced transient vomiting. No symptoms of dumping or bacterial overgrowth were observed. All had normal liver enzymes. Hypocalcaemia (20.8 %) and zinc deficiency (25.6 %) resolved with oral supplementation. Type 2 diabetes mellitus resolved in 80.3 % and improved in the remainder of patients, hypertension resolved in 92.3 % and improved in the rest.ConclusionsWhilst currently an investigative procedure, and within the studies limitations combined sleeve gastrectomy with modified jejuno-ileal bypass is safe and effective, and evades many problems associated with current bariatric operations whilst offering maintained excess weight loss.