\n Metabolic and bariatric surgery (MBS) is recommended for individuals with a body mass index (BMI)\n >\n 35 kg/m\n 2\n, regardless of presence, absence, or severity of co-morbidities.\n

随着我国腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy,LSG)在减重手术中所占比例逐年增加,LSG术后复胖问题日益显现,正确认识和处理复胖具有重要的现实意义。近年来,再次胃袖状切除、腹腔镜Roux-en-Y胃旁路术(laparoscopic Roux-en-Y gastric bypass,LRYGB)、单吻合口胃旁路术以及胃袖状切除附加手术等作为初次手术失败后的修正手术均显示出良好的疗效,而对于LSG术后复胖的修正手术选择,国内外尚无一致意见,如何选择合适的修正手术方式来保证病人达到最佳疗效并获益,逐渐成为减重代谢外科领域探索的新热点方向。该文结合文献分别对LSG术后复胖常见的修正手术进行分析论述,为LSG术后复胖修正手术的术式选择提供参考。

This survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity.A three-round Delphi survey with 136 statements was conducted by 43 experts in obesity management comprising 26 bariatric surgeons, 4 endoscopists, 8 endocrinologists, 2 nutritionists, 2 counsellors, an internist, and a pediatrician spanning six continents over a 2-day meeting in Hamburg, Germany. To reduce bias, voting was unanimous, and the statements were neither favorable nor unfavorable to the issue voted or evenly balanced between favorable and unfavorable. Consensus was defined as ≥ 70% inter-voter agreement.Consensus was reached on all 15 essential definitional and reporting statements, including initial suboptimal clinical response, baseline weight, recurrent weight gain, conversion, and revision surgery. Consensus was reached on 95/121 statements on the type of surgical procedures favoring Roux-en-Y gastric bypass, sleeve gastrectomy, and endoscopic sleeve gastroplasty. Moderate consensus was reached for sleeve gastrectomy single-anastomosis duodenoileostomy and none on the role of intra-gastric balloons. Consensus was reached for MBS in patients > 65 and < 18 years old, with a BMI > 50 kg/m, and with various obesity-related complications such as type 2 diabetes, liver, and kidney disease.In this survey of 43 multi-disciplinary experts, consensus was reached on standardized definitions and reporting standards applicable to the whole medical community. An algorithm for treating patients with obesity was explored utilizing a thoughtful multimodal approach.© 2023. The Author(s).

腹腔镜胃袖状切除术(laparoscopic sleeve gastrectomy, LSG)是目前国内外开展最广泛的减重手术术式。随着手术的开展,术后复胖等各种原因造成的修正手术比例也逐年增加,如何个体化选择合适的修正术式并规范地开展修正手术是目前减重外科面临的热点问题之一。此文结合文献和作者临床经验就LSG术后修正手术的原因、术式选择等问题展开概述,为修正手术的规范化开展提供思路。

Although revisions account for 17% of cases performed at bariatric centers of excellence, scarce data exists on whether index operation type influences outcomes after secondary operations.We designed a study investigating the effect of primary procedure type on weight loss and perioperative complications after conversion bariatric surgery.Tertiary Referral Hospital, USA.We performed a retrospective review of patients undergoing conversion from sleeve gastrectomy (SG) or adjustable gastric band (AGB) to Roux-en-Y gastric bypass (RYGB) from 2009 to 2019. Post-operatively, we measured short- and medium-term complications and changes in body weight at various time points. Univariate and regression analyses were performed.Forty-two (SG) patients and 116 (AGB) patients underwent conversion to RYGB, most commonly for GERD (57.1%) in SG patients vs. weight regain (77.6%) in AGB patients. Mean pre-conversion BMI was 36.7 kg/m (SG) vs 43.8 kg/m (AGB). Mean time to conversion (months) was 52.9 (SG) vs 94.7 (AGB). Complication rate was 9.5% (SG) vs 6% (AGB) at 30 days (p = 0.48) and 31%(SG) vs 14.5% (AGB) (p = 0.02) at 2 years. Mean post conversion %TWL was 11.6% (SG) vs 24.6% (AGB) in patients with GERD/dysphagia (p = 0.014) and 20.7% (SG) vs 27.6% (AGB) in patients converted for weight-related reasons (p = 0.027) at 1 year. Overall mean %TWL was 13.2% (SG) vs 24.7% (AGB) at 2 years (p < 0.0035).After conversion to RYGB, patients with AGB experience better short- and medium-term weight loss than those with SG, even after accounting for conversion indications. SG to RYGB conversions have a higher resolution of reflux disease.© 2022. The Society for Surgery of the Alimentary Tract.

Laparoscopic sleeve gastrectomy (LSG) has rapidly become increasingly popular in bariatric surgery. However, in the long-term follow-up, weight loss failure and intractable severe acid reflux after primary LSG can necessitate further interventions. The purpose of this study was to evaluate our initial case series regarding the complications and short-term weight loss results of the ReSleeve Gastrectomy (ReSG). From January 2010 to February 2016, all patients who underwent ReSG were included in this study. From a retrospective database, the demographic data, surgical history, comorbidities, American Society of Anaesthesiologists (ASA) score, time interval between the two procedures, and intra- and postoperative parameters and outcomes were analyzed. ReSG was performed for 25 patients (7 men) with a mean age of 49 years (±11). Indications for ReSG were weight loss insufficiency for 1 patient (4%), weight regain for 23 patients (92%), and an acute dysphagia due to a residual fundic pouch for 1 patient (4%). Mean reoperation time before ReSG was 2.9 years (±1.5). The mean body mass index (BMI) for ReSG was 43.9 kg/m (±9.4). The first 4 patients (16%) had a barium swallow and the next 21 (84%) patients a computed tomography scan volumetry with a mean gastric volume of 526.7 cc (±168). All procedures were completed by laparoscopy with no intraoperative complication. An additional procedure was carried out for 3 patients (12%), including 1 cholecystectomy and 2 hiatal hernia repairs. Mean length of hospital stay was 5.2 days (±4.2), with no postoperative death. The complication rate was 60% ( = 15) including a Dindo-Clavien grade 2 complication for 7 patients (28%) and grade 3 for 8 patients (32%). One patient was lost to follow-up (4%). The mean BMI before RSG was 43.9 kg/m (±9.4). At a mean follow-up after ReSG of 37.3 months (range 6-80), the mean BMI and percentage of excess weight loss were, respectively, 35 kg/m (±6.7) and 38.2% (±19). ReSG should be proposed only for well-selected cases. This study has led us to change our habits by selecting only patients with a large gastric pouch ≥500 mL or with unresected fundus. Further prospective clinical trials are required to compare the outcomes of ReSG with those of laparoscopic Roux-en-Y gastric bypass or duodenal switch for weight loss failure after LSG.

Efficacy and safety of OAGB/MGB (one anastomosis/mini gastric bypass) have been well documented both as primary and as revisional procedures. However, even after OAGB/MGB, revisional surgery is unavoidable in patients with surgical complications or insufficient weight loss.A questionnaire asking for the total number and demographics of primary and revisional OAGB/MGBs performed between January 2006 and July 2020 was e-mailed to all S.I.C. OB centres of excellence (annual caseload > 100; 5-year follow-up > 50%). Each bariatric centre was asked to provide gender, age, preoperative body mass index (BMI) and obesity-related comorbidities, previous history of abdominal or bariatric surgery, indication for surgical revision of OAGB/MGB, type of revisional procedure, pre- and post-revisional BMI, peri- and post-operative complications, last follow-up (FU).Twenty-three bariatric centres (54.8%) responded to our survey reporting a total number of 8676 primary OAGB/MGBS and a follow-up of 62.42 ± 52.22 months. A total of 181 (2.08%) patients underwent revisional surgery: 82 (0.94%) were suffering from intractable DGER (duodeno-gastric-esophageal reflux), 42 (0.48%) were reoperated for weight regain, 16 (0.18%) had excessive weight loss and malnutrition, 12 (0.13%) had a marginal ulcer perforation, 10 (0.11%) had a gastro-gastric fistula, 20 (0.23%) had other causes of revision. Roux-en-Y gastric bypass (RYGB) was the most performed revisional procedure (109; 54%), followed by bilio-pancreatic limb elongation (19; 9.4%) and normal anatomy restoration (19; 9.4%).Our findings demonstrate that there is acceptable revisional rate after OAGB/MGB and conversion to RYGB represents the most frequent choice.© 2021. The Author(s).