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1.
Background: Long-term complications leading to reoperation after primary bariatric surgery are not uncommon. Reoperations
are particularly challenging because of tissue scarring and adhesions related to the first operation. Reoperations must address
the complication(s) related to the scarring and, at the same time, prevent weight regain that would inevitably occur after
simple reversal. Conversion to Roux-en-Y gastric bypass (RYGBP) has repeatedly been demonstrated to be the procedure of choice
in most situations. It has traditionally been performed through an open approach. Our aim is to describe our experience with
the laparoscopic approach in reoperations to RYGBP over the past 5 years. Methods: All patients undergoing laparoscopic RYGBP as a reoperation were included in this study. Patients with multiple previous operations or patients with band erosion
after gastric banding were submitted to laparotomy. Data were collected prospectively. Results: Between June 1999 and August
2004, 49 patients (44 women, 5 men) underwent laparoscopic reoperative RYGBP. The first operation was gastric banding in 32
and vertical banded gastroplasty in 15. The mean duration of the reoperation was 195 minutes. No conversion to open was necessary.
Overall morbidity was 20%, with major complications in 2 patients (4%). Weight loss, or weight maintenance, was satisfactory,
with a BMI <35 kg/m2 up to 4 years in close to 75% of the patients. Conclusions: Laparoscopic RYGBP can be safely performed as a reoperation in
selected patients provided that the surgical expertise is available. These procedures are clearly more difficult than primary
operations, as reflected by the long operative time. Overall morbidity and mortality, however, are not different. Long-term
results regarding weight loss or weight maintenance are highly satisfactory, and comparable to those obtained after laparoscopic
RYGBP as a primary operation. 相似文献
2.
Background: Laparoscopic Roux-en-Y gastric bypass (RYGBP) is being performed widely as a treatment of choice for morbid obesity.
We present our method and experience with the first 150 consecutive cases of laparoscopic RYGBP with a 2-m long biliopancreatic
limb (BP-limb). Methods: Between November 2001 and November 2003, a prospective analysis of 150 patients was performed identifying
technical success and complications. Before surgery, patients underwent a strict multidisciplinary behavioral program. At
operation the stomach was transected proximally with a linear stapler (60-mm, Endo-GIA) to create a prolongation of the esophagus
(gastric tube) along the lesser curvature, resulting in a 40-50 ml pouch. Two meters of the proximal jejunum were bypassed
(BP-limb), creating an antecolic Roux-en-Y gastro-jejunostomy to the posterior wall of the gastric tube using a 45-mm linear
Endo-GIA stapler. The entero-anastomosis was created 50 cm below the gastro-jejunostomy, also with a 45-mm linear Endo-GIA.
Results: Mean BMI was 50.0, and 78% of patients were females. With 100% follow-up, we found an EWL of 50% 6 months after surgery,
gradually rising to 80% after 18 months. The mean operating time was 116 min for the first 50 cases and decreased to 82 min
for the last 50 cases. Intestinal leakage occurred in 5 patients (3%) and bleeding in 5 (3%). Most of these complications
occurred in the first 50 cases, and all but one were treated successfully with an early laparoscopic re-operation. Marginal
ulcers were found in 16.6% of patients. No internal hernias have occurred. Conclusion: The operation demands advanced laparoscopic
skills, but technically it is relatively simple and has an acceptable complication rate. Short-term results regarding excess
weight loss are at least comparable to the RYGBP with a long alimentary limb. 相似文献
3.
Laparoscopic Pouch Resizing and Redo of Gastro-jejunal Anastomosis for Pouch Dilatation following Gastric Bypass 总被引:2,自引:0,他引:2
Background: With a dramatically increasing number of bariatric operations performed world-wide in the recent years, more late
complications have been noticed. Proximal gastric pouch dilatation is a known late complication after laparoscopic or open
restrictive surgery for morbid obesity. In the present paper, we report our experience with laparoscopic re-operation of enlarged
gastric pouches after laparoscopic gastric bypass, with emphasis on technique and outcome. Methods: Data were retrieved from
a prospective database of 334 patients who underwent a laparoscopic gastric bypass operation at the University Hospital of
Zurich from July 2000 to December 2004. Five laparoscopic revisions for pouch dilatation after primary bypass were performed.
Results: 3 female and 2 male patients with median age 40 years (range 32-55) underwent a laparoscopic pouch resizing. At the
time of the re-operation, the median BMI was 32.0 kg/m2 (range 28.4-48.4). All procedures were performed laparoscopically with no conversion to open surgery. The median operating-time
was 110 minutes (95-120). The median hospital stay was 6 days (range 5-14). The median BMI in the follow-up of 12 months (9-14)
was 28.0 kg/m2 (25.5-45.8). Diabetes mellitus improved in 4 cases during follow-up. Conclusion: Laparoscopic pouch resizing with redo of
the gastro-jejunal anastomosis was feasible, safe and effective in this small series. It led to further weight loss and improved
symptoms of poor pouch emptying. 相似文献
4.
Background: The feasibility of laparoscopic Roux-en-Y gastric bypass (Lap-RYGBP) for morbid obesity is well documented. In
a prospective randomized trial, we compared laparoscopic and open surgery. Methods: 51 patients (48 females, mean (± SD) age
36 ± 9 years and BMI 42 ± 4 kg/m2) were randomly allocated to either laparoscopy (n=30) or open surgery (n=21). All patients were followed for a minimum of
1 year. Results: In the laparoscopy group, 7 patients (23%) were converted to open surgery due to various procedural difficulties.
In an analysis, with the converted patients excluded, the morphine doses used postoperatively were significantly (p< 0.005)
lower in the laparoscopic group compared to the open group. Likewise, postoperative hospital stay was shorter (4 vs 6 days,
p<0.025). Six patients in the laparoscopy group had to be re-operated due to Roux-limb obstruction in the mesocolic tunnel
within 5 weeks. The weight loss expressed in decrease in mean BMI units after year was 14 and 13 after 1 ± 3 ± 3 laparoscopy
and open surgery,respectively (not significant). Conclusions: Both laparoscopic and open RYGBP are effective and well received
surgical procedures in morbid obesity. Reduced postoperative pain, shorter hospital stay and shorter sick-leave are obvious
benefits of laparoscopy but conversions and/or reoperations in 1/4 of the patients indicate that Lap-RYGBP at present must
be considered an investigational procedure. 相似文献
5.
Background: We evaluated the safety and feasibility of performing a laparoscopic intracorporeal end-toside small bowel anastomosis
using a stapling technique as part of a Roux-en-Y gastric bypass operation (RYGBP). Methods: 80 consecutive patients who underwent
RYGBP with laparoscopic jejunojejunostomy were evaluated. Operative time and intraoperative and postoperative complications
directly related to the jejunojejunostomy anastomosis were recorded. Results: All 80 laparoscopic jejunojejunostomy procedures
were successfully performed without conversion to laparotomy. Mean operative time was longer for the first 40 laparoscopic
RYGBP than for the last 40 RYGBP (32±18 min vs 21±14 min, respectively, p<0.05). Intraoperative complications were staple-line
bleeding (2 patients) and narrowing of the anastomosis (1 patient). Postoperative complications were four small bowel obstructions:
technical narrowing at jejunojejunostomy site (2 patients), angulation of the afferent limb (1 patient), and food impaction
at the jejunojejunostomy anastomosis (1 patient). These four patients underwent successful laparoscopic re-exploration and
creation of another jejunojejunostomy proximal to the original anastomosis. There were no small bowel anastomotic leaks. The
median time to resuming oral diet was 2 days. Conclusions: Laparoscopic jejunojejunostomy as part of the RYGBP operation is
a safe and technically feasible procedure. Postoperative small bowel obstruction is a potential complication, which can be
prevented by avoiding technical narrowing of the afferent limb. 相似文献
6.
Continued Excellent Results with the Mini-Gastric Bypass: Six-Year Study in 2,410 Patients 总被引:5,自引:2,他引:3
Background: There is a growing body of evidence showing that the Mini-Gastric Bypass (MGB) is a safe and effective alternative
to other bariatric surgical operations. This study reports on the results of a consecutive cohort of patients undergoing the
MGB. Methods: A prospective database was used to continuously assess the results in 2,410 MGB patients treated from September
1997 to February 2004. Results:The average operative time was 37.5 minutes, and the median length of stay was 1 day. The 30-day
mortality and complication rates were 0.08% and 5.9% respectively. The leak rate was 1.08%. Average weight loss at 1 year
was 59 kg (80% of excess body weight). The most frequent long-term complications were dyspepsia and ulcers (5.6%) and iron
deficiency anemia (4.9%.) Excessive weight loss with malnutrition occurred in 1.1%. Weight loss was well maintained over 5
years, with <5% patients regaining more than 10 kg. Conclusions: Overall, the MGB is very safe initially and in the long-term.
It has reliable weight loss and complications similar to other forms of gastric bypass. 相似文献
7.
Revision of Failed Gastric Bypass to Distal Roux-en-Y Gastric Bypass: A Review of 65 Cases 总被引:1,自引:1,他引:0
Fobi MA Lee H Igwe D Felahy B James E Stanczyk M Tambi J Eyong P 《Obesity surgery》2001,11(2):190-195
Background: No bariatric operation has been documented to effect adequate weight loss in all patients. Patients with inadequate
weight loss or significant weight regain with an anatomically intact short-limb gastric bypass, of which the Fobi pouch operation
(FPO) for obesity is a modification, are usually revised to a distal Roux-en-Y gastric bypass (DRYGBP) to enhance weight loss.
Method: A retrospective review of the charts of all patients who had a revision to a DRYGBP at our Center during an 8-year
period was carried out and the findings analyzed. Results: 65 patients who had the FPO had a revision to the DRYGBP.Most were
super obese patients who, even though they had lost significant weight, were still morbidly obese. Some were patients who
had not lost adequate weight or <40% excess weight, and a small number were patients who requested more weight loss even though
they had a BMI of < 35. 15 patients developed protein malnutrition requiring supplemental feeding. 6 required rerevision to
short-limb gastric bypass. Conclusion: Revision of short-limb gastric bypass to DRYGBP usually enhances weight loss but at
a cost of an increased incidence of protein malnutrition. 相似文献
8.
Marano BJ 《Obesity surgery》2005,15(3):342-345
Background: Roux-en-Y gastric bypass (RYGBP) is a common surgical intervention for morbid obesity. Postoperative GI symptoms
are common. This study reports the endoscopic findings in symptomatic patients. Methods: Patients who developed GI symptoms
after RYGBP at a single community hospital were referred for endoscopic evaluation. Standard endoscopic procedures using standard
endoscopic equipment were used. Results: From April 2002 to April 2004, 23 out of 200 patients underwent 35 endoscopic procedures.
All patients complained of some degree of epigastric pain, nausea and vomiting regardless of endoscopic findings. The most
common endoscopic finding was ulcer disease (12 patients - 52%). Other findings included normal postoperative anatomy (7 patients
- 30%), anastomotic stricture (1 patient - 4.3%), obstructed biliopancreatic limb (1 patient - 4.3%), acute gastric pouch
bleed (1 patient - 4.3%), anastomotic rupture/dehiscence (1 patient - 4.3%). H. pylori was not detected in any patient. Conclusions: In patients who have had RYGBP, symptoms were a poor predictor of endoscopic
pathology. Ulcer disease was the most common endoscopic finding. These ulcers were not associated with H. pylori. All ulcers responded well to oral proton pump inhibitors (PPI) and sucralfate therapy. The community gastroenterologist
should be acquainted with the typical post-surgical anatomy and possible endoscopic intervention for RYGBP patients. 相似文献
9.
Laparoscopic band repositioning for pouch dilatation/slippage after gastric banding: disappointing results 总被引:5,自引:0,他引:5
Suter M 《Obesity surgery》2001,11(4):507-512
Background: Pouch dilatation with or without slippage of the band is a serious complication of gastric banding, often attributed
to initial malpositioning of the band. Food intake is increased, and weight regain occurs. Progressive rotation of the band
follows, leading to functional stenosis and dysphagia. Reoperation is necessary in most cases, and may consist of band removal,
band change, band repositioning, or conversion to another bariatric procedure. Material and Methods: The study consisted of
chart review of all patients who underwent laparoscopic repositioning of the band for pouch dilatation/slippage, and long-term
follow-up through regular office visits and phone calls. Results: Among 272 patients who had laparoscopic gastric banding,
20 (7.3 %) developed pouch dilatation and/or slippage, of whom 19 underwent reoperation. Laparoscopic band repositioning was
performed in 9 patients. One of them developed an intraabdominal collection postoperatively and required percutaneous CT-guided
drainage. Recovery was uneventful in the other 8. Follow-up since reoperation varies from 13 to 42 months (mean 20 months).
The result was good in 2 patients who lost further weight, satisfactory in 1 whose weight remained stable, and unsatisfactory
in 6 patients. Weight loss was insufficient in 2, dilatation recurred in 2, and band infection or erosion developed each in
1 patient. 5 patients required further surgery: band removal in 3 and conversion to gastric bypass in 2. Conclusions: Laparoscopic
band repositioning is feasible and safe if pouch dilatation and/or slippage develops after gastric banding.The mid-term results
are disappointing in two-thirds of the patients. In some patients, pouch dilatation could result from poor adjustment to diet
restriction rather than merely from original malplacement. Conversion to gastric bypass may be a better option in these cases. 相似文献
10.
Background: Laparoscopic gastric bypass (LGBP) is a well-established procedure for the surgical management of morbid obesity.
Most surgeons create the gastroenteral anastomosis by using the circular EEA stapler. We describe an alternative laparoscopic
anastomotic technique using the EndoGIA linear stapling device. Methods: The stomach was proximally transected with a linear
stapler (45 mm, Endo-GIA) to create a 15 to 20 ml pouch. Next, an antecolic Roux-en-Y gastroenterostomy was performed, using
the 45 mm Endo-GIA. The proximal loop of the intestine was then separated from the anastomotic site by the Endo-GIA. Finally,
the Endo-GIA was used for the intraabdominal creation of a side-to-side enteroenterostomy. Results: Between June and August
2001, 5 patients with mean BMI 56.7 kg/m2±7.3 underwent LGBP. All patients were seen 6 months post-surgery. Operating time was 7.5 and 6.5 hours for the first 2 operations,
but was under 4.5 h for the next 3 cases. 1 patient suffered from perioperative hypoxia leading to long-term artificial respiration.
6 weeks after surgery, 1 patient developed obstruction due to torsion of the enteroenterostomy and required open revision.
The 3 remaining patients made an uneventful recovery. All patients lost considerable weight (mean 36.5 kg; [range 32 to 45]
after 6 months). No stenosis or anastomotic leakage was noted. Conclusions: A linear stapled anastomosis is an alternative
to the use of the circular stapler. 相似文献
11.
Open banded gastric bypass has been the choice of some bariatric surgeons. This procedure includes a band (of various materials)
around the gastric pouch. While there are advantages to this band, erosion and/or displacement of the band may occur. We describe
a case of a symptomatic displaced band which was treated by laparoscopic removal. Laparoscopic removal of the band after open
banded gastric bypass is feasible. Revision of previous bariatric surgery may be performed laparoscopically if the technical
expertise is available. 相似文献
12.
Background: Bariatric surgery is the only method for sustained weight loss in morbid obesity. However, 10-25% of patients
will require re-operation for unsatisfactory weight loss or weight regain after restrictive surgery. Re-operation is associated
with higher morbidity and mortality. This study is to evaluate the s a fety and efficacy of laparoscopic mini-gastric bypass
(LMGB) for failed vertical banded gastroplasty (VBG). Methods: From May 2001 to March 2003, 29 consecutive patients underwent
LMGB for failed VBG. Average age was 39.7 years (range 22 to 56), and average BMI before re-operation was 41.7 kg/m2 (range 35.0-70.8). 8 patients had previous open VBG, and 21 had laparoscopic VBG. The re-operation was for regain of weight
in 16 patients, inadequate weight loss in 10 patients, and severe reflux esophagitis in 3 patients. Re-operation was performed
after an average of 58.5 months (range 14 to 180). Results: All the re-operations were completed laparoscopically. Average
operative time was 171.4 minutes (range 130 to 290). There was 1 mortality, due to leakage (3.4%). 1 re-operation was necessary,
for incarceration of small bowel in a trocar wound 10 days after the LMGB (3.4%). 1 anastomotic site bleeding and 1 wound
infection occurred. Average BMI 12 months after the LMGB was 32.1 kg/m2 (range 26.4 to 42.7). The quality of life study was significantly improved. The revision operation had much more technical
difficulty for those with previous open VBG than laparoscopic VBG. Conclusion: LMGB is an effective and safe revision operation
for patients with failed VBG. A large series and long-term follow up is needed for confirmation. 相似文献
13.
Early Experience with Two-Stage Laparoscopic Roux-en-Y Gastric Bypass as an Alternative in the Super-Super Obese Patient 总被引:6,自引:16,他引:6
Background: Surgical management of the supersuper obese patient (BMI >60 kg/m2) has been a challenging problem associated with higher morbidity, mortality, and long-term weight loss failure. Current limited
experience exists with a two-stage biliopancreatic diversion and duodenal switch in the supersuper obese patient, and we now
present our early experience with a two-stage gastric bypass for these patients. Methods: We completed a retrospective bariatric
database and chart review of super-super obese patients who underwent laparoscopic sleeve gastrectomy as a first-stage procedure
followed by laparoscopic Roux-en-Y gastric bypass as a second-stage for more definitive treatment of obesity. Results: During
a two-year period, 7 patients with BMI 58-71 kg/m2 underwent a two-stage laparoscopic Roux-en-Y gastric bypass by two surgeons at the Mount Sinai Medical Center. 3 patients
were female, 4 patients were male, and the average age was 43. Prior to the sleeve gastrectomy, the mean weight was 181 kg
with a BMI of 63. Average time between procedures was 11 months. Prior to the second-stage procedure, the mean weight was
145 kg with a BMI of 50 and average excess weight loss of 37 kg (33% EWL). Six patients have had follow-up after the second-stage
procedure with an average of 2.5 months. At follow-up the mean weight was 126 kg with a BMI of 44 and average excess weight
loss of 51 kg (46% EWL). The mean operative times for the two procedures were 124 and 158 minutes respectively. The average
length of stay for all procedures was 2.7 days. 4 patients had 5 complications, which included splenic injury, proximal anastomotic
stricture, left arm nerve praxia, trocar site hernia, and urinary tract infection.There were no mortalities in the series.
Conclusions: Laparoscopic sleeve gastrectomy with second-stage Roux-en-Y gastric bypass are feasible and effective procedures
based on short-term results. This two-stage approach is a reasonable alternative for surgical treatment of the high-risk supersuper
obese patient. 相似文献
14.
Bowel Obstruction after Laparoscopic Roux-en-Y Gastric Bypass 总被引:5,自引:5,他引:0
Background: Bowel obstruction has been frequently reported after laparoscopic Roux-en-Y gastric bypass (LRYGBP). The aim of
this study was to review our experience with bowel obstruction following LRYGBP, specifically examining its etiology and management
and to strategize maneuvers to minimize this complication. Methods: We retrospectively reviewed the charts of 9 patients who
developed postoperative bowel obstruction after LRYGBP. Each chart was reviewed for demographics, timing of bowel obstruction
from the primary operation, etiology of obstruction, and management. Results: 9 of our initial 225 patients (4%) who underwent
LRYGBP developed postoperative bowel obstruction. The mean age was 46 ± 12 years, with mean BMI 47 ± 9 kg/m2. 6 patients developed early bowel obstruction, and 3 patients developed late bowel obstruction. The mean time interval for
development of early bowel obstruction was 16 ±16 days. The causes for early bowel obstruction included narrowing of the jejunojenunostomy
anastomosis (n=3), angulation of the Roux limb (n=2), and obstruction of the Roux limb at the level of the transverse mesocolon
(n=1). The mean time interval for development of late bowel obstruction was 7.4 ± 0.5 months. The causes for late bowel obstruction
included internal herniation (n=2) and adhesions (n=1). 6 of 9 bowel obstructions (66%) were considered technically related
to the learning curve of the laparoscopic approach. Eight of the 9 patients required operative intervention, and 6 of the
8 reoperations were managed laparoscopically. Management included laparoscopic bypass of the jejunojejunostomy obstruction
site (n=5), open reduction of internal hernia (n=2), and laparoscopic lysis of adhesion (n=1). Conclusions: Bowel obstruction
is a frequent complication after LRYGBP, particularly during the learn ing curve of the laparoscopic approach. Specific measures
should be instituted to minimize bowel obstruction after LRYGBP as most of these complications are considered technically
preventable. 相似文献
15.
Rhabdomyolysis is a rare complication of serious surgical procedures, and constitutes a clinical and biochemical syndrome,
caused by injury and destruction of skeletal muscles. It is accompanied by pain in the region of the referred muscle group,
increase in creatine phosphokinase levels, myoglobinuria, often with severe renal failure, and finally multi-organ system
failure and death, if not treated in time. The main risk factor in the development of postoperative rhabdomyolysis is prolonged
intraoperative immobilization of the patient. Morbidly obese patients who undergo laparoscopic bariatric operations should
be considered high-risk for rhabdomyolysis, from extended immobilization and pressure phenomena in the lumbar region and gluteal
muscles. We report a 20-year-old woman with BMI 51, who underwent a prolonged laparoscopic Roux-en-Y gastric bypass. Postoperatively,
she presented severe myalgia in the gluteal muscles and lumbar region, oliguria and creatine phosphokinase levels that reached
38,700 U/L. She was treated with intensive hydration and analgesics, and did not develop acute renal failure because diagnosis
and treatment were attained immediately. 相似文献
16.
Neri A Mariani F Testa M Piccolomini A Vuolo G Guarnieri A Carli AF Di Cosmo L 《Obesity surgery》2001,11(2):229-231
Background: Late proximal pouch dilatation (LPPD) has occurred occasionally following gastric banding for morbid obesity.
At present, laparoscopic conservative resetting and oversuturing of the band is considered the standard procedure for pouch
dilatation without any important posterior component. Methods: Two cases of LPPD are presented, which occurred in our initial
experience with the LapBand?, corrected via a laparoscopic approach. Results: The reintervention was necessary in both patients,
with conservative laparoscopic repositioning and oversuturing of the band in the first case and laparoscopic substitution
of the gastric band in the second. We have not observed further complications, and weight loss has been maintained in a midterm
outcome in both cases (30 and 18 months follow-up). Conclusions: LPPD can be corrected with a conservative laparoscopic surgical
approach, without complications and negative functional effects on mid-term outcome. 相似文献
17.
The Orientation of the Antecolic Roux Limb Markedly Affects the Incidence of Internal Hernias after Laparoscopic Gastric Bypass 总被引:5,自引:5,他引:0
Background: Internal herniation of the bowel may be a late complication after the laparoscopic Roux-en-Y gastric bypass (RYGBP).
A seemingly minor change in technique is described that significantly prevents herniation behind the Roux limb mesentery.
We hypothesized that internal hernias behind the Roux limb mesentery occur more frequently when the Roux limb is oriented
such that the distal tip is toward the lesser curvature of the gastric pouch with the bowel then curving to the patient's
left, compared with the opposite orientation. Methods: A retrospective chart review was performed of our prospectively collected
database. A change in surgical technique occurred June 2003, in an attempt to reduce internal hernia formation. We compared
200 consecutive antecolic left-oriented RYGBP operations performed immediately previous to June 2003 (Group A) with 200 consecutive
antecolic right-oriented RYGBP operations performed after June 2003 (Group B). Results: There was an 9.0% rate of internal
hernia formation in Group A (18/200) and a 0.5% rate of internal hernia formation in Group B. Internal hernias were repaired
an average of 1.2 years after surgery (range 4–30 months, median 14.3 months). The average length of follow-up was 2.1 and
1.6 years in Groups A and B, respectively. All herniations were behind the Roux limb mesentery. The difference in hernia formation
after the change in technique was significant (P<0.005). Conclusions: With a simple change in technique, the incidence of internal herniation behind the Roux limb mesentery
may be significantly reduced or eliminated. 相似文献
18.
Background: Controversy exists regarding the best surgical treatment for super-obesity (BMI >50 kg/m 2 ). The two most common
bariatric procedures performed worldwide are laparoscopic adjustable gastric banding (LAGB) and laparoscopic Roux-en-Y gastric
bypass (LRYGBP). We undertook a retrospective single-center study to compare the safety and efficacy of these two operations
in super-obese patients. Methods: 290 super-obese patients underwent laparoscopic bariatric surgery: 179 LAGB and 111 LRYGBP.
Results: There were one death in both groups. The early complication rate was higher in the LAGB group (10% vs 2.8%, P<0.01). Late complication rate was higher in the LAGB group (26% vs 15.3%, P<0.05). Operating time and hospital stay were significantly higher in the LRYGBP group. LRYGBP had significantly better excess
weight loss than LAGB (63% vs 41% at 1 year, and 73% vs 46% at 2 years), as well as lower BMI than LAGB (35 vs 41 at 18 months).
Conclusion: LRYGBP results in significantly greater weight loss than LAGB in super-obese patients, but is associated with
a higher early complication rate. 相似文献
19.
Carbajo M García-Caballero M Toledano M Osorio D García-Lanza C Carmona JA 《Obesity surgery》2005,15(3):398-404
Background: One-Anastomosis Gastric Bypass (OAGB) by laparoscopy consists of constructing a divided 25-ml (estimated) gastric
pouch between the esophago-gastric junction and the crow's foot level, parallel to the lesser curvature, which is anastomosed
latero-laterally to a jejunal loop 200 cm distal to the ligament of Treitz. Methods: The results of our first 209 OAGB patients
operated from July 2002 to June 2004 are reported. Mean age was 41 years (14-66), BMI 48 (39-86) and mean excess body weight
66 kg (35-220). In 144 patients, OAGB was the only operation performed, and in 61 patients it was accompanied by other surgery
(18 cholecystectomies, 5 incisional hernia repairs, and 38 adhesiolysis), and in 4 patients a restrictive bariatric operation
had been performed previously. Results: 2 patients (0.9%) were converted to open surgery due to uncontrollable bleeding. 3
patients (1.4%) needed re-operation in the immediate postoperative period. 5 patients (2.3%) needed prolonged hospital stay
due to acute pancreatitis in 1 and anastomotic leakage in 4, all resolving with conservative treatment. 2 patients died (0.9%),
1 from fulminant pulmonary thromboembolism and 1 from nosocomial pneumonia. Long-term complications have occurred in only
2 patients who developed clinically significant iron-deficiency anemia. Mean excess weight loss was 75% after 1 year and >80%
at 2 years. Conclusion: OAGB is a simple, safe and effective operation with less perioperative risk than conventional gastric
bypass, quicker return to normal activities, and better quality of life. 相似文献
20.
Advanced laparoscopic operations can be performed in patients who have previously undergone laparoscopic gastric bypass, because
there are fewer adhesions than after open procedures. Also, revisions of previous laparoscopic gastric bypasses can be done
laparoscopically for the same reasons. To demonstrate this, we present a patient who had undergone a laparoscopic gastric
bypass. The operation was successful initially. After 10 months, she started to regain some of her lost weight. It was also
found that she had developed idiopathic thrombocytopenia purpura, which was unresponsive to steroids. She underwent a splenectomy
and revision of her gastric bypass, both done laparoscopically. This case demonstrates that these advanced laparoscopic procedures
can be performed safely, even after previous surgery. 相似文献