Surg Endosc：腹腔镜下可调式胃束带术失败后的修正手术

　　近日来自加拿大的研究人员Ahmad Elnahas研究指出，腹腔镜下可调式胃束带术已成为全球最常实施的减肥手术之一，不幸的是，20% ～30%的病例需要修正手术。该文发表在 2013年第27卷第3期《内镜外科》（Surg Endosc）杂志上。

　　研究者报告了已提出的几种修正策略，不过对最佳手术选择尚无共识。本篇系统评价旨在确定腹腔镜下胃束带术因并发症或减重不充分而失败后，何种修正手术最适用于促进减重。

　　研究团队对EMBASE、MEDLINE、PsycINFO和Cochrane临床试验进行最全面的检索后总共确定了24篇相关文章。作者们报告有2名研究者独立提取数据，通过协商解决差异，计算出减重的加权平均值。他们对总共106、514和71名接受了腹腔镜下可调式胃束带术，并分别中转腹腔镜下袖套式胃切除术、腹腔镜下Roux-en-Y胃旁路术和腹腔镜下胆胰转流及十二指肠改道手术的患者进行了评价。修正手术前，腹腔镜下袖套式胃切除术、腹腔镜下Roux-en-Y胃旁路术和腹腔镜下胆胰转流及十二指肠改道手术组加权平均体重指数分别为39、43和41kg/m2。大多数数据于随访12～24个月时报告。

　　研究者注意到该时间段内腹腔镜下袖套式胃切除术、腹腔镜下Roux-en-Y胃旁路术和腹腔镜下胆胰转流及十二指肠改道手术组平均体重指数分别为28、32和33kg/m2。此外，超重体重平均减重在腹腔镜下袖套式胃切除术、腹腔镜下Roux-en-Y胃旁路术和腹腔镜下胆胰转流及十二指肠改道手术组分别为22%、58%和47%。随访2年后腹腔镜下胆胰转流及十二指肠改道手术组超重体重减重达到78%。最好是通过改为另一减肥术式来处理腹腔镜下胃束带术失败的方法。

　　Elnahas医师的团队评论说：“挽救性腹腔镜下Roux-en-Y胃旁路术可获得稳定的体重下降；虽然修正性胆胰转流及十二指肠改道手术的结果看上去富有希望，但还需要更多的方法学质量更高的研究来证实”。

与胃束带相关的拓展阅读：

• Medscape：胃束带手术可长期缓解代谢综合征
  
• 更多信息请点击：有关胃束带更多资讯

Revisional surgery after failed laparoscopic adjustable gastric banding: a systematic review
BACKGROUND
Laparoscopic adjustable gastric banding (LAGB) has emerged as one of the most commonly performed bariatric procedures worldwide. Unfortunately, revisional surgery is required in 20-30 % of cases. Several revisional strategies have been proposed, but there is no consensus regarding the best surgical option. This systematic review was designed to determine which revisional surgery (laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, or laparoscopic biliopancreatic diversion with duodenal switch) is best suited to enhance weight loss following failed LAGB due to complications or inadequate weight loss.
METHODS
EMBASE, MEDLINE, PsycINFO, and Cochrane Clinical Trials were searched using the most comprehensive timeline for each database. A total of 24 relevant articles were identified. Two investigators independently extracted data, and differences were resolved by consensus. The weighted means were calculated for weight loss measurements.
RESULTS
A total of 106, 514, and 71 patients underwent conversion from LAGB to laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic biliopancreatic diversion and duodenal switch (BPDDS), respectively. Before revisional surgery, the weighted mean body mass index (BMI) was 38.8 (6.9), 43.3 (8.1), and 41.3 (7.2) kg/m(2) for the LSG, LRYGB, and BPDDS groups, respectively. The majority of data was reported at 12-24 months follow-up. The mean BMI within this interval was 28 (10.5), 32.2 (6.4), and 33 (5.7) kg/m(2) for the LSG, LRYGB, and BPDDS groups, respectively. In addition, the mean excess weight loss (EWL) was 22 % (2.8), 57.8 % (11.7), 47.1 % (14) for the LSG, LRYGB, and BPDDS groups, respectively. The EWL reached 78.4 % (35) in the BPPDS group after 2-year follow-up.
CONCLUSIONS
Failed LAGB is best managed with conversion to another bariatric procedure. Stable weight loss occurs with salvage LRYGB. Although results for revisional BPPDS appear promising, additional research, with higher methodological quality, is needed.