Secondary surgery after sleeve gastrectomy: Roux-en-Y gastric bypass or biliopancreatic diversion with duodenal switch.

Autor:	Homan J; Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands. Electronic address: jhoman@rijnstate.nl., Betzel B; Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands., Aarts EO; Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands., van Laarhoven KJ; Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands., Janssen IM; Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands., Berends FJ; Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Jazyk:	angličtina
Zdroj:	Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery [Surg Obes Relat Dis] 2015 Jul-Aug; Vol. 11 (4), pp. 771-7. Date of Electronic Publication: 2014 Oct 14.
DOI:	10.1016/j.soard.2014.09.029
Abstrakt:	Background: Laparoscopic sleeve gastrectomy (LSG) has gained popularity as a stand-alone procedure with good short-term results for weight loss. However, in the long-term, weight regain and other complications are reported. Demand for secondary surgery is rising, partly for these reasons. Objectives: To review the indications and effects of secondary surgery, biliopancreatic diversion with duodenal switch (BPD/DS) versus laparoscopic Roux-en-Y gastric bypass (LRYGB), after LSG. Methods: Data from all patients who underwent revision of LSG was retrospectively analyzed, concerning data on indications for secondary surgery, weight loss, and complications. Results: 43 Patients underwent secondary surgery after LSG; 25 BPD/DS and 18 LRYGB, respectively. Main indications for secondary surgery were inadequate weight loss (n = 17 [40%]) and weight regain (n = 8 [19%]). For these indications, the median excess weight loss was greater for BPD/DS (59% [range 15-113]) compared to LRYGB (23% [range -49-84]) (P = .008) after 34 months (range 14-79). In case of dysphagia or gastroesophageal reflux disease the complaints resolved after converting to LRYGB. BPD/DS patients were more likely to develop a short-term complication and vitamin deficiencies compared to LRYGB. Conclusions: Secondary surgery of LSG to BPD/DS or LRYGB is feasible with slightly more complications after BPD/DS. Conversion to LRYGB is preferred in cases of dysphagia or gastroesophageal reflux disease. In cases of weight regain or insufficient weight loss after LSG, patients had better weight loss with a BPD/DS; however, this procedure has the risk of complications, such as severe vitamin deficiencies. (Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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