The first case report of failed single-anastomosis-duodeno-ileal bypass converted to One anastomosis gastric bypass/Mini-gastric bypass.
The first case report of failed single-anastomosis-duodeno-ileal bypass converted to One anastomosis gastric bypass/Mini-gastric bypass.
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DOI：
10.1016/j.ijscr.2017.04.020
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发表时间：
2017
影响因子：
0.6
通讯作者：
Weiner R
中科院分区：
文献类型：
--
作者：
Chiappetta S;Stier C;Scheffel O;Theodoridou S;Weiner R
未来，修复式减肥手术的数量将会增加。已建立的单吻合-十二指肠-回肠搭桥术加袖状胃切除(SADI-S)是手术的限制性部分。由于保留了幽门，SG有高压系统的缺点，从长远来看，会使现有的胃食道反流性疾病重新出现或恶化。一次吻合胃旁路/微创胃旁路(OAGB/MGB)降低了OAGB/MGB低压系统中SG的高压系统。OAGB/MGB可能是抢救SADI-S失败患者的一种简单方法。单吻合式十二指肠回肠搭桥术(SADI-S)是在袖式胃切除术(SG)的基础上进行的。由于保留了幽门，SG的缺点是高压系统从头开始或现有胃食道反流病(GERD)恶化。一名女性患者因长期GERD和多次减肥手术后体重恢复而现身。患者的初始体重为158千克(体重指数为62.5千克/平方米)，于2009年接受了可调节胃束带术。在滑脱中摘除带子后，患者于2012年接受了体重135千克的SG。SG后9个月，SADI-S作为吸收不良的第二步手术进行。32个月后，患者在质子泵抑制剂治疗下发生了严重的GERD。实际体重为107.9千克(体重指数42.7千克/平方米)。高位内窥镜检查显示有裂孔疝气和乙型食管炎，并行背部裂孔成形术。术后6个月仍存在重度GERD，体重恢复，改行腹腔镜单吻合术(OAGB/MGB)，以减少OAGB/MGB低压系统中SG的高压系统。翻修手术一年后，据报道仅偶尔发生反流。体重进一步下降(91 kg，BMI 36 kg/m2，EWL 67.7%)。SG作为SADI-S的限制性部分，可能会导致胃肠道反流病，从而病理性地摄入“软”热量，从而失败手术，导致体重回升。OAGB/MGB可能是抢救这些失败的SADI-S患者的一种简单方法。
Revisional bariatric surgery will rise in the future. The established single-anastomosis-duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as the restrictive part of the procedure. Due to preserved pylorus, SG has the disadvantage of a high-pressure system with de-novo or worsening of existing gastroesophageal reflux disease in the long-term. One anastomosis gastric bypass/Mini-gastric bypass (OAGB/MGB) reduces the high-pressure system of SG in a low-pressure system of OAGB/MGB. OAGB/MGB might be a simple method to rescue failed SADI-S patients. The established single-anastomosis-duodeno-ileal bypass with sleeve gastrectomy (SADI-S) is based on a sleeve gastrectomy (SG) as the restrictive part of the procedure. Due to preserved pylorus, SG has the disadvantage of a high-pressure system with de novo or worsening of existing gastroesophageal reflux disease (GERD). A female patient presented herself due to protracted GERD and weight regain after multiple bariatric surgeries. At an initial weight of 158 kg (BMI 62.5 kg/m2) the patient underwent adjustable gastric banding in 2009. After band removal in slippage, the patient underwent SG at a weight of 135 kg in 2012. Nine months after SG, SADI-S was performed as a malabsorptive second step procedure. After 32 months the patient suffered from severe GERD under proton pump inhibitor therapy. Actual weight was 107.9 kg (BMI 42.7 kg/m2). Upper endoscopy showed a hiatal hernia and esophagitis B and dorsal hiatoplasty was performed. After 6 months in still existing severe GERD and weight regain indication for laparoscopic conversion to One anastomosis gastric bypass/Mini-gastric bypass (OAGB/MGB) was given, aiming to reduce the high-pressure system of SG in a low-pressure system of OAGB/MGB. One year after revisional surgery reflux was reported to be only occasionally. Further weight loss was seen (91 kg, BMI 36 kg/m2, EWL 67.7%). SG as the restrictive part of SADI-S may lead to GERD and consequently to pathologic eating of “soft” calories, that defeats the operation and results in weight regain. OAGB/MGB might be a simple method to rescue such failed SADI-S patients.