Περίληψη:
A considerable number of patients require revisional surgery after
laparoscopic adjustable gastric banding (LAGB). Studies that compared
the outcomes of revisional sleeve gastrectomy (r-SG) and revisional
Roux-en-Y gastric bypass (r-RYGB) after failed LAGB are scarce in the
literature. Our objective was to determine whether significant
differences exist in outcomes between r-SG and r-RYGB after failed LAGB.
From 2005 to 2012, patients who underwent laparoscopic r-SG and r-RYGB
after failed LAGB were retrospectively compared and analyzed. Data
included demographics, indication for revision, operative time, hospital
stay, conversion rate, percentage excess weight loss (%EWL), and
morbidity and mortality.
Out of 693 bariatric procedures, 42 r-SG and 53 r-RYGB were performed.
The median preoperative weight (107.7 and 117.7 kg, respectively, p =
0.02) and body mass index (BMI) (38.5 vs. 43.2 kg/m(2), respectively, p
= 0.01) were statistically significantly lower in r-SG than in r-RYGB.
The mean operative time and median hospital stay were significantly
shorter in r-SG than in r-RYGB (108.4 vs. 161.2 min, p < 0.01) (2 vs. 3
days, p = 0.02), respectively. One patient underwent conversion to open
surgery after r-RYGB (p = 0.5). The reoperation rate was lower in r-SG
than in r-RYGB (0.0 vs. 3.8 %, p = 0.5). There was one postoperative
leak in the r-RYGB, and the overall complication rate was significantly
lower in r-SG patients than in r-RYGB patients (7.1 vs. 20.8 %, p =
0.05). The mean follow-up was significantly shorter in the r-SG group
(9.8 vs. 29.3 months, p < 0.01). However, the mean postoperative BMI was
not different at 1 year (32.3 vs. 34.7, p = 0.29) as well as mean %EWL
was (47.4 vs. 45.6 %, p = 0.77).
Both r-SG and r-RYGB are safe procedures with similar outcomes in terms
of %EWL. As a result of the long-term potential nutritional
complication of r-RYGB, r-SG may be a better option in this group of
patients. Longer follow-up is needed.
Συγγραφείς:
Khoursheed, Mousa
Al-Bader, Ibtisam
Mouzannar, Ali and
Al-Haddad, Abdulla
Sayed, Ali
Mohammad, Ali
Fingerhut, Abe
