Abstract:

Cause analysis and treatment of reoperative metabolic and bariatric surgery：A report of 54 cases        PENG Ju-zheng，GUAN Bing-sheng，YANG Jing-ge，et al. Department of Bariatric and Metabolic Surgery，the First Affiliated Hospital of Jinan University，Guangzhou 510630，China
Corresponding author：WANG Cun-chuan，E-mail：twcc@jnu.edu.cn
Abstract    Objective    To explore the cause and treatment of bariatric and metabolic surgery reoperation. Methods    A retrospective analysis was conducted on the clinical data of 54 patients underwent reoperative metabolic and bariatric surgery in Department of Bariatric and Metabolic Surgery，the First Affiliated Hospital of Jinan University from November 2000 to December 2018, and the reasons and surgical techniques of reoperation were analyzed. Results Causes of reoperation included inadequate weight loss/weight regain in 22 cases（40.7%），adhesive intestinal obstruction in 5 cases（9.3%），mesenteric hernia in 5 cases （9.3%），gastroesophageal reflux in 4 cases（7.4%），anastomotic leakage 4 cases (7.4%)，anastomotic ulcer bleeding in 3 cases (5.6%)，anastomotic stenosis in 3 cases (5.6%)，postoperative intra-abdominal bleeding in 3 cases (5.6%)，recurrent diabetes in 2 cases(3.7%)，severe dumping syndrome in 2 cases (3.7%)，anastomotic error in 1 case (1.9%). Reoperation methods mainly included Roux-en-Y gastric bypass in 30 cases (55.6%)，sleeve gastrostomy in 10 cases (18.5%)，hernia repair in 5 cases (9.3%)，exploratory laparotomy hemostasis in 4 cases (7.4%)，gastroscopic balloon dilatation in 2 cases (3.7%)，restoration surgery in 1 case (1.9%)，revisional banded gastric bypass with GaBP ring in 1 case (1.9%), hiatal hernia repair in 1 case(1.9%). A total of 54 patients underwent reoperation with a follow-up period of 1 to 102 months. Among them, 42 patients were followed up，and 12 patients were lost to follow-up (follow-up rate of 77.8%). Among the 42 patients who were followed up, 41 of them achieved good results after surgery, and the symptoms and signs were relieved to various degrees.  Conclusion    The most common cause of reoperative metabolic and bariatric surgery is inadequate weight loss/weight regain. The choice of reoperation method depends on the primary surgical procedure , the cause of failure , and the intraoperative condition.

Key words: obesity, bariatric and metabolic surgery, reoperation, Roux-en-Y gastric bypass, sleeve gastrostomy

摘要：

目的    探讨减重代谢外科再手术的原因及手术处理方法。方法    回顾性分析2000年11月至2018年12月暨南大学附属第一医院减重代谢外科收治的54例减重手术后再手术病人的临床资料，分析手术原因和再手术方式选择。结果    再手术原因主要包括体重下降不充分或复胖22例（40.7%）、粘连性肠梗阻5例（9.3%）、肠系膜裂孔疝5例（9.3%）、胃食管反流4例（7.4%）、吻合口漏4例（7.4%）、吻合口溃疡出血并穿孔3例（5.6%）、吻合口狭窄3例（5.6%）、术后腹腔出血3例（5.6%）、糖尿病复发2例（3.7%）、严重倾倒综合征2例（3.7%）、吻合错误1例（1.9%）。再手术方式主要包括Roux-en-Y胃旁路术30例（55.6%）、胃袖状切除术10例（18.5%）、内疝修补术5例（9.3%）、腹腔镜探查止血4例（7.4%）、胃镜球囊扩张术2例（3.7%）、修正复原术1例（1.9%）、GaBP环束带式胃旁路修正术1例（1.9%）、食管裂孔疝修补术1例（1.9%）。随访1~102个月，失访12例（随访率77.8%），获得随访的42例病人术后均取得良好效果，再手术前症状均得到不同程度缓解。结论  减重代谢外科再手术最常见的原因是术后体重下降不充分或复胖，再手术方式的选择应根据初次手术方式、失败原因以及术中具体情况而定。

关键词: 肥胖症, 减重代谢外科, 再手术, 胃旁路术, 胃袖状切除术