胃束带术失败后修正性Roux-en-Y胃旁路术的临床表现与结局：直接与袖状胃辅助路径的比较。

文献信息

中文摘要

背景： 可调节胃束带术（AGB）失败后，患者可能直接转换为Roux-en-Y胃旁路术（RYGB），或在修正性旁路术前先经过中间阶段的袖状胃切除术（SG）。这些不同修正路径对临床表现和术后结局的影响仍不明确。
方法： 本研究为回顾性队列研究，纳入2013年至2025年间在单一学术中心接受既往AGB后修正性RYGB的成年患者。患者被分为直接AGB-RYGB组和两步法AGB-SG-RYGB转换组。比较了临床表现、围手术期结局、术后并发症、体重下降轨迹和合并症缓解情况。
结果： 78例患者在既往AGB后接受修正性RYGB，包括53例直接AGB-RYGB转换和25例AGB-SG-RYGB转换。直接转换的患者更常表现为体重反弹症状（81.1% vs 16.0%，p < 0.01），且术前BMI更高（43.1 ± 7.4 vs 36.1 ± 7.2 kg/m2，p < 0.01）。相比之下，AGB-SG-RYGB组更常表现为反流和上消化道症状，包括吞咽困难、腹痛以及恶心或呕吐（均p < 0.01）。围手术期结局，包括失血量、住院时间、术后并发症、再入院和再干预，在两组间相当。大多数手术采用机器人方式完成。直接AGB-RYGB组的手术时间略长（202.2 ± 40.5 vs 193.9 ± 51.3 min，p = 0.05）。接受直接AGB-RYGB的患者在6、12和24个月时获得更大的总体重下降百分比和超重体重下降百分比（均p ≤ 0.03），而AGB-SG-RYGB组表现出更大的术后GERD症状缓解。两组均显示肥胖相关合并症的术后改善。
结论： 在AGB失败后接受修正性RYGB的患者，根据修正路径不同代表不同的临床人群。尽管症状特征和手术史不同，围手术期结局相当。直接AGB-RYGB组观察到更大的早期和中期体重下降，而AGB-SG-RYGB路径表现出更大的GERD症状缓解。这些发现应结合两组之间基线BMI和修正指征的差异进行解读。

英文摘要

BACKGROUND: Following failed adjustable gastric banding (AGB), patients may undergo direct conversion to Roux-en-Y gastric bypass (RYGB) or progress through an intermediate sleeve gastrectomy (SG) prior to revisional bypass. The impact of these differing revisional pathways on clinical presentation and postoperative outcomes remains unclear.
METHODS: A retrospective cohort study was performed of adult patients undergoing revisional RYGB after prior AGB between 2013 and 2025 at a single academic center. Patients were categorized into direct AGB-RYGB and two-step AGB-SG-RYGB conversion groups. Clinical presentation, perioperative outcomes, postoperative complications, weight loss trajectories, and comorbidity resolution were compared.
RESULTS: Seventy-eight patients underwent revisional RYGB after prior AGB, including 53 direct AGB-RYGB conversions and 25 AGB-SG-RYGB conversions. Patients undergoing direct conversion more commonly presented with weight regain symptoms (81.1 vs 16.0%, p < 0.01) and had higher preoperative BMI (43.1 ± 7.4 vs 36.1 ± 7.2 kg/m2, p < 0.01). In contrast, the AGB-SG-RYGB group more frequently presented with reflux and upper gastrointestinal symptoms, including dysphagia, abdominal pain, and nausea or vomiting (all p < 0.01). Perioperative outcomes, including blood loss, hospital stay, postoperative complications, readmissions, and reinterventions, were comparable between groups. Most procedures were performed robotically. Operative time was slightly longer in the direct AGB-RYGB group (202.2 ± 40.5 vs 193.9 ± 51.3 min, p = 0.05). Patients undergoing direct AGB-RYGB achieved greater % total weight loss and % excess weight loss at 6, 12, and 24 months (all p ≤ 0.03), whereas the AGB-SG-RYGB group demonstrated greater postoperative GERD symptom resolution. Both groups demonstrated postoperative improvement in obesity-related comorbidities.
CONCLUSIONS: Patients undergoing revisional RYGB after failed AGB represent distinct clinical populations depending on revisional pathway. Despite differing symptom profiles and operative histories, perioperative outcomes were comparable. Greater early and intermediate weight loss was observed in the direct AGB-RYGB group, whereas the AGB-SG-RYGB pathway demonstrated greater GERD symptom resolution. These findings should be interpreted in the context of differences in baseline BMI and indications for revision between groups.