Surgical Endoscopy ( IF 2.4 ) Pub Date : 2022-10-05 , DOI: 10.1007/s00464-022-09654-4 Jeremy Jen 1 , Hau Phan 1 , Brett Johnson 1 , Corliann Blyn 2 , Janet Lavrich 3 , Krishna Mallem 4 , Priya Kalsank Pai 5 , Piotr Krecioch 1
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Background
Recidivism after initial sleeve gastrectomy (SG) remains common. Revisional surgery to convert SG to Roux-en-Y gastric bypass (RYGB) or duodenal switch (DS) for additional weight loss is increasing. This study aims to compare the outcomes after conversion of SG to RYGB or DS.
Methods
A retrospective single-institution review was conducted from 2015 to 2021, identifying 75 patients who underwent conversion from prior SG to either RYGB (40) or DS (35). Mean excess body weight loss (EBWL) at 3, 6, 12, and 24 months was assessed and compared. Secondary measures of length of stay (LOS), procedure length, and 30-day readmission rate were also reviewed.
Results
Percentage EBWL for RYGB vs DS was 24.0% vs 18.8% at 3 months (N = 36 vs 26; P < 0.0491), 34.8% vs 29.0% at 6 months (N = 29 vs 17; P < 0.2192), 43.0% vs 40.1% at 12 months (N = 28 vs 12; P < 0.6828), and 36.2% vs 41.7% at 24 months (N = 27 vs 7; P < 0.5553). Average LOS was 2.6 days ± 1.4 for RYGB and 2.8 days ± 1.3 for DS (P < 0.6032). Average procedure length was 134.4 min for RYGB and 189.8 min for DS (P < 0.0001). 30-day readmission rate was 27.5% (N = 11) for RYGB and 14.3% (N = 5) for DS (P < 0.1645). Significant weight loss was observed in both subgroups up to 12 months, with no significant weight loss between 12 and 24 months (RYGB N = 21, P < 0.2961; DS N = 5, P < 0.7233).
Conclusion
Both revisional RYGB and revisional DS procedures had significant and sustained weight loss in the first 12 months. There was no significant excess body weight loss difference between revisional RYGB and revisional DS patients at 6, 12, and 24 months, with only significant greater weight loss for RYGB patients at 3 months. Additionally, procedure length was significantly longer for DS compared to RYGB, with no significant differences in LOS and 30-day readmission rates.
Graphical abstract
中文翻译：
比较社区医院袖状胃切除术转为 Roux-en-Y 胃绕道手术与十二指肠转手术后的减肥效果
背景
初次袖状胃切除术（SG）后的再犯仍然很常见。将 SG 改为 Roux-en-Y 胃绕道手术 (RYGB) 或十二指肠转术 (DS) 以进一步减轻体重的修复手术正在增加。本研究旨在比较 SG 转换为 RYGB 或 DS 后的结果。
方法
2015 年至 2021 年进行了一项回顾性单机构审查，确定了 75 名从之前的 SG 转换为 RYGB（40 例）或 DS（35 例）的患者。评估并比较第 3、6、12 和 24 个月时的平均过度体重减轻 (EBWL)。还审查了住院时间 (LOS)、手术时间和 30 天再入院率等次要指标。
结果
3 个月时 RYGB 与 DS 的 EBWL 百分比分别为 24.0% vs 18.8%（N = 36 vs 26；P < 0.0491），6 个月时为 34.8% vs 29.0%（N = 29 vs 17；P < 0.2192），43.0% vs 12 个月时为 40.1%（N = 28 vs 12；P < 0.6828），24 个月时为 36.2% vs 41.7%（N = 27 vs 7；P < 0.5553）。RYGB 的平均 LOS 为 2.6 天 ± 1.4，DS 的平均 LOS 为 2.8 天 ± 1.3（P < 0.6032）。RYGB 的平均手术时间为 134.4 分钟，DS 的平均手术时间为 189.8 分钟（P < 0.0001）。RYGB 的 30 天再入院率为 27.5%（N = 11），DS 的 30 天再入院率为 14.3%（N = 5）（P < 0.1645)。在长达 12 个月的时间内，两个亚组均观察到显着的体重减轻，但在 12 至 24 个月之间没有显着的体重减轻（RYGB N = 21，P < 0.2961；DS N = 5，P < 0.7233）。
结论
修订版 RYGB 和修订版 DS 手术在前 12 个月内均实现了显着且持续的体重减轻。在 6、12 和 24 个月时，修正 RYGB 和修正 DS 患者之间没有显着的过度体重减轻差异，仅 RYGB 患者在 3 个月时体重减轻显着更大。此外，与 RYGB 相比，DS 的手术时间明显更长，但 LOS 和 30 天再入院率没有显着差异。
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