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首页> 外文期刊>Surgical Endoscopy >Roux-en-Y gastric bypass as a salvage procedure in complicated patients with failed fundoplication(s)
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Roux-en-Y gastric bypass as a salvage procedure in complicated patients with failed fundoplication(s)

机译：Roux-Zh-Y胃旁路作为复杂患者的救生程序失败的原石处的患者

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BackgroundIn symptomatic patients after failed fundoplication, reoperation is considered. In complex or obese patients, Roux-en Y gastric bypass (RYGB) may be the best operation. We sought to characterize the outcomes of patients with failed fundoplication to undergo salvage RYGB, and to compare these outcomes to patients undergoing reoperative fundoplication.MethodsA prospectively maintained database was queried for procedures performed at a single institution from 2011 to 2017. GERD health-related quality of life (HRQL) surveys were administered at defined intervals.ResultsThirty-six patients underwent salvage RYGB and 84 patients underwent reoperative fundoplication. The RYGB cohort had a higher BMI (35.56.8 vs. 28.7 +/- 5.3, p<0.01), more gastroparesis (52.8% vs. 9.5%, p<0.01), more esophagitis (42.9% vs. 20.2%, p=0.01), and more prior fundoplications (1.9 vs. 1.2, p<0.01). The incidence of gastroparesis and esophagitis was directly related to the number of failed fundoplications (p<0.05). Operative times were longer with RYGB (332.7 +/- 131.5 vs. 200.0 +/- 67.6min, p<0.01) as was length of stay (4.3 +/- 3.4 vs. 2.8 +/- 1.5days, p=0.02), incidence of Clavien-Dindo complicationsGrade 3 (19.4% vs. 4.8%, p=0.01), 30-day reoperation (11.1% vs. 1.2%, p=0.01), and 30-day readmission (32.4% vs. 11.9%, p<0.01). In five patients with three or more prior fundoplication attempts, an esophagojejunostomy was necessary. If these patients are excluded, there was no difference for RYGB with gastrojejunostomy compared to reoperative fundoplication for complications, reoperations, or readmissions. GERD-HRQL scores were similar prior to surgery in both cohorts and improved significantly and to a similar degree on long-term follow-up.Conclusions In a complex cohort of patients with high rates of obesity and numerous failed previous fundoplication attempts, conversion to RYGB results in good symptomatic outcomes. Patients with three or more previous fundoplication attempts are more likely to require esophagojejunostomy. Complication rates in this subset of patients appear to be quite high.
机译：背景症状患者失败后的基底刺激，重新进入被考虑。在复杂或肥胖的患者中，Roux-Zh Y胃旁路（RYGB）可能是最好的操作。我们试图将患者的患者表征失败，以进行挽救救助性RYGB，并将这些结果与经过复杂的基金的患者进行比较。从2011年到2017年的单一机构执行的程序查询了预期维护的数据库。凸德健康相关质量寿命（HRQL）调查以定义的间隔给药。患者患者接受了救助RYGB和84名患者进行了高档基础药用症。 Rygb Cohort具有更高的BMI（35.56.8与28.7 +/- 5.3，P <0.01），胃术（52.8％vs.9.5％，P <0.01），更多的食管炎（42.9％与20.2％，P = 0.01），更先前的基金，1.9对1.2，P <0.01）。胃流离失所和食管炎的发生率与失败的基金会数量直接相关（P <0.05）。 rygb的操作时间更长（332.7 +/- 131.5与200.0 +/- 67.6min，P <0.01），持续长度（4.3 +/- 3.4与2.8 +/- 1.5days，p = 0.02）， Clavien-Dindo改性的发病率3（19.4％vs.4.8％，P = 0.01），重新进食（11.1％vs.1.2％，p = 0.01）和30天的阅约（32.4％与11.9％， P <0.01）。在五名患有三名或更多的先前基金会尝试的患者中，是必要的食道jejunostomy。如果排除这些患者，与RygB与GastrojejunoStomy没有差异，与复杂性，重新进展或入伍的功能不可能。在两个群组中手术之前，GERD-HRQL分数在手术中具有显着改善，并且在长期随访中提高了类似程度。复杂肥胖率的复杂队列和许多失败的先前的基础药物尝试，转换为RYGB导致良好的症状结果。以前的三个或更多的基本专业专利尝试的患者更有可能需要食道jejunostomy。这种患者的并发症率似乎相当高。

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