Management of Complications and Outcomes After Revisional Bariatric Surgery: 3-Year Experience at a Bariatric Center of Excellence

被引:34
作者
Abdelgawad, Mohamed [1 ,2 ,3 ]
De Angelis, Francesco [1 ,2 ]
Iossa, Angelo [1 ,2 ]
Rizzello, Mario [1 ,2 ]
Cavallaro, Giuseppe [1 ,2 ]
Silecchia, Gianfranco [1 ,2 ]
机构
[1] Univ Roma La Sapienza, Dept Med Surg Sci & Biotechnol, Div Gen Surg, Via F Faggiana 1668, I-04100 Latina, Italy
[2] Univ Roma La Sapienza, Bariatr Ctr Excellence IFSO EU, Via F Faggiana 1668, I-04100 Latina, Italy
[3] Mansoura Univ, Gastroenterol Surg Ctr, Fac Med, Mansoura, Egypt
关键词
Revisional bariatric surgery; Morbid obesity; Leak; Fistula; Laparoscopic surgery; Complications; Y GASTRIC BYPASS; WEIGHT-LOSS; SLEEVE;
D O I
10.1007/s11695-016-2071-x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Laparoscopic revisional bariatric surgery (RBS) is increasingly common. A tailored decision-making process is advocated. In this retrospective study, we reviewed the RBS experience of a single center, analyzing perioperative complications to provide insight into management options and midterm outcomes. Records from November 2011 to March 2015 were reviewed from prospectively maintained database. Six hundred eighteen patients underwent laparoscopic bariatric procedures; of these, 81 (13.1 %) underwent RBS. Patients with a minimum follow-up of 6 months (n = 77) were evaluated. Fifty-nine underwent revised laparoscopic sleeve gastrectomy, and 18 underwent revised Roux-en-Y gastric bypass. Indications for RBS were inadequate weight loss or weight regain in 42 cases (54.5 %) and gastroesophageal reflux disease (GERD), procedure-related complications, or technical failure in 35 cases (45.5 %). There were no deaths or conversions to open surgery. After a mean follow-up of 22 months, body mass index (BMI) decreased from 40.9 +/- 6.7 to 31.9 +/- 4.8 kg/m(2), mean % excess weight loss (%EWL) was 58 +/- 24.3 %, and 55.3 % of patients had resolution of comorbidities. Eight major complications (10.4 %) occurred: five leaks and three intra-abdominal hematomas. Non-surgical management succeeded in 50 % of complications. This study confirms that RBS is challenging; a complication rate of 10 % is expected. Major surgery can be avoided when devoted endoscopists and radiologists are available. Intensive follow-up after complications allows early diagnosis and treatment of unfavorable sequelae. RBS induced a mean %EWL of 58 % at 2 years and resolution of comorbidities in 50 % of cases. However, the durability of these effects remains questionable.
引用
收藏
页码:2144 / 2149
页数:6
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