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修正性减重与代谢手术的国际动态与发展趋势
Global development and future trends in revisional metabolic and bariatric surgery
修正性减重与代谢手术（RBS）始终伴随减重与代谢外科的发展。各种减重与代谢手术（MBS）术后均可能因疗效不佳、体重反弹、营养不良或并发症而需要再次手术。RBS按手术目的可分为修改、复原和修复3类：修改是将原术式转换为其他术式，以改善减重及代谢疾病治疗效果；复原是恢复原有解剖或生理状态；修复则用于治疗术后并发症。与初次手术相比，RBS解剖关系复杂、操作难度大、围手术期风险高，对术者的理论基础、手术技能及团队协作能力提出了更高要求。近年来，肠促胰素类减重药物的广泛应用对RBS的发展产生了明显影响，国际RBS手术量有所下降；但中国MBS仍处于增长阶段，未来RBS需求可能持续增加。Roux-en-Y胃旁路术仍是目前应用较广泛的修正术式。机器人辅助手术在复杂解剖分离和精细操作方面具有一定优势，可能成为RBS的重要技术平台。规范把握适应证、重视多学科评估并依据较高级别临床证据合理选择术式，是推动RBS安全、规范发展的关键。
Revisional metabolic and bariatric surgery (RBS) has evolved alongside metabolic and bariatric surgery (MBS). Patients may require reoperation after any type of MBS because of unsatisfactory treatment outcomes, weight regain, malnutrition, or postoperative complications. Based on the surgical purpose, RBS can be classified into three types: conversion, restoration, and repair. Conversion changes the primary procedure to another operation to improve weight loss and metabolic outcomes; restoration re-establishes the original anatomical or physiological state; and repair treats postoperative complications. Compared with primary surgery, RBS involves more complex anatomy, greater technical difficulty, and higher perioperative risks, thereby placing greater demands on surgeons’ theoretical knowledge, operative skills, and multidisciplinary teamwork. In recent years, the widespread use of incretin-based anti-obesity medications has substantially influenced the development of RBS, and the international volume of RBS has declined. In China, however, the volume of MBS continues to increase, and the demand for RBS may rise accordingly. Roux-en-Y gastric bypass remains one of the most widely used revisional procedures. Robotic assistance offers potential advantages in complex dissection and precise manipulation and may become an important technical platform for RBS. Appropriate patient selection, multidisciplinary assessment, and evidence-based procedure selection are essential for the safe and standardized development of RBS.
减重与代谢手术 / 修正性减重手术 / 减重药物 / 机器人辅助手术
metabolic and bariatric surgery / revisional bariatric surgery / incretin-based anti-obesity medication / robot-assisted surgery
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Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the most common surgical treatment for morbid obesity in Denmark. Internal herniation (IH) or intermittent internal herniation (IIH) is a major late complication after LRYGB due to persistent mesenteric defects. However, the incidence of IH/IIH is still not known in Denmark.The primary aim of the study was to assess the incidence of IH/IIH after LRYGB performed in the period between 2006 and 2011 with a follow-up until 2013, where mesenteric defects were not routinely closed during the primary operation.Department of Bariatric Surgery, Koege University Hospital, DenmarkWe performed a retrospective nationwide analysis of prospectively collected data from all patients with LRYGB performed in Denmark from 2006 to 2011 based on the Danish National Patient Registry (NPR). From January 2006 to December 2011, 12,221 patients underwent an LRYGB procedure in Denmark. Relevant data from all 12,221 patients were retrieved from the NPR during the follow-up period from January 2006 to May 2013; we registered possible subsequent abdominal operations in these patients.Operations were performed on 398 patients because of suspected IH/IIH; 383 of these patients had IH/IIH (3.1%; 95% CI 2.8-3.5). The estimate for the 5-year cumulative incidence of clinically significant cases with IH/IIH was 4%. The median time interval until the onset of IH/IIH after LRYGB was 15 months (range 0-67 months) in a follow-up period with a median of 38 months (range 16-87 months).In the period from 2006 to 2011, mesenteric defects were not routinely closed during LRYGB in Denmark. The cumulative 5-year incidence of IH/IIH after LRYGB was 4% in a median follow-up period of 38 months (range 16-87) in Denmark when data was retrieved from the NPR.Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
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Internal hernia (IH) is a serious complication following laparoscopic Roux-en-Y gastric bypass (LRYGB), and closure of mesenteric defect has been recommended to reduce this complication. But what kind of material about suture and how to close the mesenteric defects were still controversial. The main aim of this study was to compare the incidence rate of internal hernia after LRYGB between patients with different surgical techniques.Three hundred and thirty-one patients underwent LRYGB between June 2004 and December 2017 in one single institute were retrospective analysed. The IH rate was evaluated according to different surgical methods and surgical materials before and 12 months after LRYGB.All the cases were subdivided into three groups based on the suturing method, Roux limb position, and Suture material. The mean follow up time was 36 ± 12 months, and the total incident rate of IH was 1.8% (n = 6). In the six IH cases, the duration of IH occurred time ranged from 1 month to 36 months postoperatively, and for the IH sites, one for intestinal defect, three for transverse mesocolon defect and two Peterson defect respectively. There was a significant difference about IH rate between interrupted suture and running suture groups (p = 0.011), and there were no significant differences between the other two groups.Compare with interrupted suture, running suture may prevent IH after LRYGB. Patient's gender, age, body mass index(BMI), glycometabolism condition, and Roux limb position and suture material had no effects on the IH prevalence after LRYGB.
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Migration of the staple line is the definition of sliding hiatus hernia in sleeve gastrectomy patients. The main aim was to determine the frequency and measurement of intrathoracic staple line migration and its correlation with GERD symptoms and pH monitoring.This was a prospective clinical trial including all patients who underwent sleeve gastrectomy more than 1 year previously. All the patients underwent computed tomography (CT) imaging, and migration of the proximal end of the suture above the level of the hiatus was measured in mm. All the patients with symptoms suggestive of GERD were assessed using the GERD impact scale (GIS), and wireless 24-h esophageal pH and symptom association monitoring (SAP) were carried out. Analysis of risk factors for postoperative staple line migration was performed.Between March 2018 and December 2018, 194 patients were evaluated (mean age 45.1 ± 11.2 years; 161 females); 88/194 (45.4%) presented an average intrathoracic migration of 16.2 ± 6.9 mm. Thirty-eight of 194 (19.5%) patients presented symptoms suggestive of gastroesophageal reflux. There was a significant relationship between staple line intrathoracic migration and postsleeve GERD symptomatology (p = 0.0004, OR = 4.25 [1.92-9.39]). However, there was no significant correlation between positive 24-h pH monitoring and intrathoracic migration of the staple line (p = 0.1).A migration greater than 17 mm was strongly correlated with postsleeve GERD symptoms but not with positive 24-h pH monitoring.© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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This systematic review and meta-analysis aimed to investigate the incidence of new-onset gastroesophageal reflux, reflux change, esophagitis, Barrett's esophagus, and revision due to reflux, gastritis, and marginal ulcer after one-anastomosis gastric bypass (OAGB). We performed subgroup analyses based on primary and revisional OAGB and time of follow-up. Meta-analysis of 87 studies with 27,775 patients showed a 6% rate of new-onset reflux after OAGB. Preoperative reflux status did not change significantly after OAGB. The rate of esophagitis and Barrett's esophagus was 15% and 1%, respectively. The new-onset reflux rate after OAGB was significantly higher than gastric bypass but not different with sleeve gastrectomy. The current study showed a relatively low rate of reflux and its complications after OAGB, but it was significantly higher than Roux-en-Y gastric bypass.© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
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李梦伊, 王桂琦, 于卫华, 等. 大中华减重与代谢手术数据库2025年度报告[J]. 中国实用外科杂志, 2026, 46(6): 789-803. DOI:10.19538/j.cjps.issn1005-2208.2026.06.14.
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