Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient
Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient
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DOI：
10.1381/096089203322618669
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发表时间：
2003-12-01
期刊：
影响因子：
2.9
通讯作者：
Pomp, A
中科院分区：
文献类型：
--
作者：
Regan, JP;Inabnet, WB;Pomp, A
背景资料：超-超肥胖患者（BMI >60 kg/m2）的手术治疗一直是一个具有挑战性的问题，与较高的发病率、死亡率和长期减肥失败相关。目前在超超肥胖患者中进行两阶段胆胰分流术和十二指肠转位术的经验有限，我们现在介绍我们对这些患者进行两阶段胃旁路术的早期经验。方法：我们完成了一项回顾性的肥胖数据库和图表审查，这些患者接受了腹腔镜袖状胃切除术作为第一阶段手术，随后接受了腹腔镜Roux-en-Y胃旁路术作为第二阶段手术。结果：在两年的时间里，7名BMI为58-71 kg/m2的患者在西奈山医疗中心接受了两名外科医生的两阶段腹腔镜Roux-en-Y胃旁路术。女性3例，男性4例，平均年龄43岁。在袖状胃切除术之前，平均体重为181 kg，BMI为63。手术之间的平均时间为11个月。在第二阶段手术之前，平均体重为145 kg，BMI为50，平均额外体重减轻37 kg（33% EWL）。6例患者在第二阶段手术后接受了平均2.5个月的随访。随访时，平均体重为126 kg，BMI为44，平均额外体重减轻51 kg（46% EWL）。两种手术的平均手术时间分别为124和158分钟。所有手术的平均住院时间为2.7天。4例患者发生5例并发症，包括脾损伤、近端吻合口狭窄、左臂神经失用、穿刺部位疝和尿路感染。结论：腹腔镜袖状胃切除术与第二阶段Roux-en-Y胃旁路术是可行的，有效的程序的基础上的短期结果。这种两阶段的方法是一个合理的替代手术治疗的高风险超超肥胖患者。
Background: Surgical management of the super-super obese patient (BMI >60 kg/m(2)) has been a challenging problem associated with higher morbidity, mortality, and long-term weight loss failure. Current limited experience exists with a two-stage biliopancreatic diversion and duodenal switch in the super-super obese patient, and we now present our early experience with a two-stage gastric bypass for these patients.Methods: We completed a retrospective bariatric database and chart review of super-super obese patients who underwent laparoscopic sleeve gastrectomy as a first-stage procedure followed by laparoscopic Roux-en-Y gastric bypass as a second-stage for more definitive treatment of obesity.Results: During a two-year period, 7 patients with BMI 58-71 kg/m(2) underwent a two-stage laparoscopic Roux-en-Y gastric bypass by two surgeons at the Mount Sinai Medical Center. 3 patients were female, 4 patients were male, and the average age was 43. Prior to the sleeve gastrectomy, the mean weight was 181 kg with a BMI of 63. Average time between procedures was 11 months. Prior to the second-stage procedure, the mean weight was 145 kg with a BMI of 50 and average excess weight loss of 37 kg (33% EWL). Six patients have had follow-up after the second-stage procedure with an average of 2.5 months. At follow-up the mean weight was 126 kg with a BMI of 44 and average excess weight loss of 51 kg (46% EWL). The mean operative times for the two procedures were 124 and 158 minutes respectively. The average length of stay for all procedures was 2.7 days. 4 patients had 5 complications, which included splenic injury, proximal anastomotic stricture, left arm nerve praxia, trocar site hernia, and urinary tract infection. There were no mortalities in the series.Conclusions: Laparoscopic sleeve gastrectomy with second-stage Roux-en-Y gastric bypass are feasible and effective procedures based on short-term results. This two-stage approach is a reasonable alternative for surgical treatment of the high-risk super-super obese patient.