Purpose

A subset of patients undergoing Roux-en-Y gastric bypass (RYGB) presents with either insufficient weight loss or weight regain. Data on the revisional restrictive options including laparoscopic adjustable gastric band (LAGB) is scarce. This study analyzes the mid-term efficacy and safety of LAGB as a revisional procedure after RYGB.

Methods

Data of all patients with revisional LAGB after primary RYGB between January 2011 and May 2019 were retrospectively reviewed. Outcomes included assessment of weight changes, resolution of comorbidities, and early and late complications during the study period.

Results

Twenty patients were included. The median Body Mass Index (BMI) before revisional LAGB was 34.8 (interquartile range [IQR] 31.9–38.1) kg/m². After a median follow-up of 33.5 (IQR 19.5–76.5) months, the median BMI was 28.7 (IQR 26.1–32.2) kg/m². The median additional Excess Weight Loss (EWL) was 37.6% (IQR 23–44.4), leading to a median total EWL of 79.5% (IQR 54.4–94.6). BMI and EWL post-LAGB improved significantly compared to BMI and EWL pre-LAGB (p<0.001 and p<0.001, respectively). Obstructive sleep apnea syndrome resolved 6 months after LAGB in one patient. Three band deflations occurred during the follow-up. Six patients underwent band removal after a median time of 19 (IQR 15.8–26) months. Overall, thirteen patients underwent a reoperation. There was no loss of follow-up until 5 years. After that, two patients were lost to follow-up.

Conclusion

LAGB may be a salvage option after failed RYGB. However, the high rate of revisions after secondary LAGB needs to be taken into consideration.

中文翻译：

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Roux-en-Y 胃绕道手术中的可调节胃束带——值得吗？

目的

部分接受 Roux-en-Y 胃旁路术 (RYGB) 的患者体重减轻或体重反弹不足。包括腹腔镜可调节胃束带（LAGB）在内的修正限制性选择的数据很少。本研究分析了 LAGB 作为 RYGB 后修正程序的中期疗效和安全性。

方法

回顾性分析了 2011 年 1 月至 2019 年 5 月原发 RYGB 后所有翻修 LAGB 患者的数据。结果包括评估研究期间的体重变化、合并症的解决以及早期和晚期并发症。

结果

包括20名患者。修正 LAGB 前的中位体重指数 (BMI) 为 34.8（四分位距 [IQR] 31.9–38.1）kg/m ²。中位随访 33.5 (IQR 19.5–76.5) 个月后，中位 BMI 为 28.7 (IQR 26.1–32.2) kg/m ². 额外超重减重 (EWL) 的中位数为 37.6% (IQR 23-44.4)，导致总 EWL 的中位数为 79.5% (IQR 54.4-94.6)。与 BMI 和 LAGB 前的 EWL 相比，LAGB 后的 BMI 和 EWL 显着改善（分别为 p<0.001 和 p<0.001）。一名患者在 LAGB 后 6 个月缓解了阻塞性睡眠呼吸暂停综合征。随访期间出现了三个波段的通货紧缩。六名患者在中位时间为 19 (IQR 15.8-26) 个月后接受了条带移除。总体而言，13 名患者接受了再次手术。直到 5 年没有失访。之后，两名患者失访。

结论

在 RYGB 失败后，LAGB 可能是一种挽救选择。但是，需要考虑二次 LAGB 后的高修订率。