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 leakage4 cases(7.4%),anastomotic ulcer bleeding in 3 cases(5.6%),anastomotic stenosis in 3 cases(5.6%),postoperative intraabdominal 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.
ABSTRACT
Objective To review the efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus.Methods The Cochrane library,PubMed,China Journal Full Text Database,Chinese Scientific Journal Full Text Database,Chinese Biomedical Literature Database and Wanfang Database were searched with key words including“减重手术”,“胃切除术”,“胃绕道术”,“胃旁路手术”,“胃转流术”,“胃袖状切除术”,“糖尿病”,“bariatric surgery”,“gastric bypass”,“sleeve gastrectomy”,“diabetes,T2DM and et al.Literatures published between the time of database establishment and December 2012 were searched.Literatures focused on the comparison of the efficacies of sleeve gastrectomy and Roux-en-Y gastric bypass for the treatment of type 2 diabetes mellitus were retrieved.Data extraction and quality evaluation of the literatures were done by 2 researchers independently.Meta analysis was performed by RevMan 5.1.2 software.The count data were presented by risk ratio (RR) or odds ratio (OR),and the measurement data were presented by mean difference (MD) or standard mean difference (SMD).The heterogeneity of the literatures was analyzed by I2.Results Five literatures were retrieved,including 164 patients in the sleeve gastrectomy group and 184 patients in the Roux-en-Y gastric bypass group.The results of Meta analysis showed that Roux-en-Y gastric bypass could significantly increase the remission rate of type 2 diabetes (OR =0.48,95 ％ confidence interval:0.26-0.91,P ＜ 0.05),increase the percentage of patients without drugs during follow up (OR =0.37,95 ％ confidence interval:0.16-0.84,P ＜0.05),decrease the levels of HbA1c and body weight (MD =0.28,-0.44,95％ confidence interval:0.14-0.43,-0.76--0.13,P ＜ 0.05) when compared with sleeve gastrectomy.There was no significant difference in the incidence of complications between the 2 groups (OR =1.81,95％ confidence interval:0.20-16.73,P ＞ 0.05).Conclusion Roux-en-Y gastric bypass is superior to sleeve gastrectomy for patients with type 2 diabetes.