Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass: impact on reflux and weight loss

IF 3.5 3区 医学 Q1 SURGERY Surgery for Obesity and Related Diseases Pub Date : 2024-08-01 DOI:10.1016/j.soard.2024.04.001
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Abstract

Background

Sleeve gastrectomy (SG) is the most commonly performed weight loss operation, and its 2 most common complications are postoperative reflux and weight recurrence. There is limited evidence to guide decision-making in treating these conditions.

Objectives

To determine the efficacy of conversion of SG to Roux-en-Y gastric bypass (RYGB) for GERD management and weight loss.

Setting

Forty-one hospitals in Michigan.

Methods

We conducted a retrospective cohort study examining patients who underwent conversion of SG to RYGB from 2014 to 2022. The primary outcomes were changes in GERD-HRQL scores, anti-reflux medication use, and weight from baseline to 1 year after conversion. Secondary outcomes included 30-day postoperative complications and resource utilization.

Results

Among 2133 patients undergoing conversion, 279 (13%) patients had baseline and 1-year GERD-HRQL survey data and anti-reflux medication data. GERD-HRQL scores decreased significantly from 24.6 to 6.6 (P < .01). Among these, 207 patients (74%) required anti-reflux medication at baseline, with only 76 patients (27%) requiring anti-reflux medication at 1 year postoperatively (P < .01). Of the 380 patients (18%) with weight loss data, mean weight decreased by 68.4lbs, with a 24.3% decline in total body weight and 51.5% decline in excess body weight. In terms of 30-day complications, 308 (14%) patients experienced any complication and 89 (4%) experienced a serious complication, but there were no leaks, perforations, or deaths. Three-hundred and fifty-five (17%) patients presented to the emergency department and 64 (3%) patients underwent reoperation.

Conclusions

This study represents the largest reported experience with conversion from SG to RYGB. We found that conversion to RYGB is associated with significant improvement in GERD symptoms, reduction in anti-reflux medication use, and significant weight loss and is therefore an effective treatment for GERD and weight regain after SG. However, the risks and benefits of conversion surgery should be carefully considered, especially in patients with significant comorbidity burden.

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袖带胃切除术转为 Roux-en-Y 胃旁路术:对反流和减肥的影响
背景袖带胃切除术(SG)是最常见的减肥手术,其最常见的两种并发症是术后反流和体重复发。方法我们开展了一项回顾性队列研究,对 2014 年至 2022 年期间接受袖带胃切除术转 RYGB 的患者进行了调查。主要结果是胃食管反流-HRQL 评分、抗反流药物使用和体重从基线到转换后 1 年的变化。次要结果包括术后30天并发症和资源利用率。结果在2133名接受转换的患者中,279名(13%)患者有基线和1年的GERD-HRQL调查数据以及抗反流药物数据。胃食管反流-HRQL评分从24.6分显著降至6.6分(P <.01)。其中,207 名患者(74%)在基线时需要服用抗反流药,而术后 1 年时只有 76 名患者(27%)需要服用抗反流药(P < .01)。在有体重下降数据的 380 名患者(18%)中,平均体重下降了 68.4 磅,其中总重量下降了 24.3%,超重下降了 51.5%。在 30 天的并发症方面,308 名(14%)患者出现了任何并发症,89 名(4%)出现了严重并发症,但没有出现渗漏、穿孔或死亡。有 355 名(17%)患者到急诊科就诊,64 名(3%)患者接受了再次手术。我们发现,转为 RYGB 与胃食管反流症状的显著改善、抗反流药物用量的减少和体重的明显减轻有关,因此是治疗胃食管反流和 SG 后体重反弹的有效方法。然而,转换手术的风险和益处应仔细考虑,尤其是对于合并症负担较重的患者。
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来源期刊
CiteScore
6.70
自引率
12.90%
发文量
570
审稿时长
56 days
期刊介绍: Surgery for Obesity and Related Diseases (SOARD), The Official Journal of the American Society for Metabolic and Bariatric Surgery (ASMBS) and the Brazilian Society for Bariatric Surgery, is an international journal devoted to the publication of peer-reviewed manuscripts of the highest quality with objective data regarding techniques for the treatment of severe obesity. Articles document the effects of surgically induced weight loss on obesity physiological, psychiatric and social co-morbidities.
期刊最新文献
Editorial Board Table of Contents SOARD Category 1 CME Credit Featured Articles, Volume 20, November 2024 Cartoon Editorial Board
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