Background

One-stage revision Roux-en-Y gastric bypass (RRYGB) after Laparoscopic adjustable gastric banding (LAGB) is widely adopted, but its safety is still debated.

Objective

This study aimed to compare outcomes between primary Roux-en-Y gastric bypass (PRYGB and RRYGB after LAGB.

Method

A retrospective record-based cohort study of patients who underwent PRYGB and RRYGB for failed LAGB and completed at least 2 years of follow-up from 2008 to 2019. Propensity score matching (PSM) analysis was conducted to obtain a balanced sample of patients with RRYGB and PRYGB interventions by adjusting for baseline covariates including age and sex.

Results

Patients with PRYGB (n = 558) and RRYGB (n = 156) were included. PSM identified 98 patients for RRYGB and 98 patients for PRYGB. Both cohorts exhibited significant reductions in BMI compared to baseline values (p < 0.001), but reductions were significantly higher in PRYGB compared to those in RRGYB at 6 months (− 10.55 ± 8.54 vs. − 8.38 ± 5.07; p = 0.032), 1-year (− 21.50 ± 8.19 vs. 16.14 ± 6.93; p < 0.001), and 2 years (− 24.02 ± 7.85 vs. − 18.93 ± 6.80; p < 0.001), respectively. A significant improvement in food tolerance from the 1st to the 2nd year was seen after RYGB (p < 0.001). The rates of early and late complications were similar in both cohorts (p = 0.537, p = 1.00). Overall re-intervention rates were 5.1 and 3.1% for RRYGB and PRYGB p = 0.721). Both cohorts exhibited significant improvement in comorbidities after 2 years (p < 0.001).

Conclusions

One-stage RRYGB for failed LAGB is safe and effective with comparable rates of complications, re-interventions, and resolution of associated comorbid conditions compared to PRYGB.

中文翻译：

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倾向评分匹配分析比较初次和修正 Roux-en-Y 胃旁路术在可调节胃束带后的结果：一项基于记录的回顾性队列研究

背景

腹腔镜可调节胃束带术（LAGB）后一期翻修Roux-en-Y胃旁路术（RRYGB）被广泛采用，但其安全性仍存在争议。

客观的

本研究旨在比较 LAGB 后初次 Roux-en-Y 胃旁路术（PRYGB 和 RRYGB）之间的结果。

方法

对接受 PRYGB 和 RRYGB 治疗失败的 LAGB 并在 2008 年至 2019 年完成至少 2 年随访的患者进行基于记录的回顾性队列研究。进行倾向评分匹配 (PSM) 分析以获得 RRYGB 患者的平衡样本和 PRYGB 干预，通过调整基线协变量，包括年龄和性别。

结果

PRYGB ( n  = 558) 和 RRYGB ( n  = 156) 患者被纳入。PSM 确定了 98 名 RRYGB 患者和 98 名 PRYGB 患者。与基线值相比，两个队列均显示 BMI 显着降低 ( p  < 0.001)，但与 RRGYB 相比，PRYGB 在 6 个月时的降低幅度显着更高（− 10.55 ± 8.54 对比 − 8.38 ± 5.07；p  = 0.032），1 -年（− 21.50 ± 8.19 对比 16.14 ± 6.93；p  < 0.001）和 2 年（− 24.02 ± 7.85 对比 − 18.93 ± 6.80；p  < 0.001）。RYGB 治疗后第 1 年到第 2 年的食物耐受性显着改善 ( p  < 0.001)。两组的早期和晚期并发症发生率相似（p  = 0.537，p  = 1.00）。RRYGB 和 PRYGB 的总体再干预率分别为 5.1% 和 3.1% p  = 0.721)。2 年后，两个队列的合并症均有显着改善 ( p  < 0.001)。

结论

与 PRYGB 相比，一期 RRYGB 治疗失败的 LAGB 是安全有效的，并发症发生率、再干预和相关合并症的解决率相当。