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Revisional bariatric surgery: Perioperative morbidity is determined by type of procedure

机译：补体减肥手术：围手术期发病率由手术类型决定

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Background: Revisional bariatric procedures are on the rise. The higher complexity of these procedures has been reported to lead to increased risk of complications. The objective of our study was to compare the perioperative risk profile of revisional bariatric surgery with primary bariatric surgery in our experience. Methods: A prospectively maintained database of all patients undergoing bariatric surgery by three fellowship-trained bariatric surgeons from June 2005 to January 2013 at a center of excellence was reviewed. Patient demographics, type of initial and revisional operation, number of prior gastric surgeries, indications for revision, postoperative morbidity and mortality, length of stay, 30-day readmissions, and reoperations were recorded. These outcomes were compared between revisional and primary procedures by the Mann-Whitney or Chi square tests. Results: Of 1,556 patients undergoing bariatric surgery, 102 patients (6.5 %) underwent revisional procedures during the study period. Indications for revisions included inadequate weight loss in 67, failed fundoplications with recurrent gastroesophageal reflux disease in 29, and other in 6 cases. Revisional bariatric procedures belonged into four categories: band to sleeve gastrectomy (n = 23), band to Roux-en-Y gastric bypass (n = 25), fundoplication to bypass (n = 29), and other (n = 25). Revisional procedures were associated with higher rates of readmissions and overall morbidity but no differences in leak rates and mortality compared with primary procedures. Band revisions had similar length of stay with primary procedures and had fewer complications compared with other revisions. Patients undergoing fundoplication to bypass revisions were older, had a higher number of prior gastric procedures, and the highest morbidity (40 %) and reoperation (20 %) rates. Conclusions: In experienced hands, many revisional bariatric procedures can be accomplished safely, with excellent perioperative outcomes that are similar to primary procedures. As the complexity of the revisional procedure and number of prior surgeries increases, however, so does the perioperative morbidity, with fundoplication revisions to gastric bypass representing the highest risk group.
机译：背景：修订型减肥程序正在增加。据报道，这些程序的较高复杂性导致并发症的风险增加。我们研究的目的是根据我们的经验比较修订型减肥手术和原发性减肥手术的围手术期风险状况。方法：回顾性研究了2005年6月至2013年1月在卓越中心由三名接受过研究金培训的肥胖外科医师进行的所有肥胖外科手术患者的前瞻性维护数据库。记录患者的人口统计资料，首次手术和翻修手术的类型，先前的胃外科手术的次数，翻修的适应症，术后发病率和死亡率，住院时间，30天再入院和再次手术。通过Mann-Whitney或卡方检验，比较了修订程序和主要程序的这些结果。结果：在进行减肥手术的1556名患者中，有102名患者（6.5％）在研究期间接受了修订程序。修订的指征包括体重减轻不足67例，胃底折叠术失败，胃食管反流反复发作29例，其他6例。修订型减肥手术分为四类：带袖胃切除术（n = 23），带Roux-en-Y胃旁路术（n = 25），胃底折叠术（n = 29）和其他（n = 25）。修订程序与更高的再入院率和总体发病率相关，但与主要程序相比，漏出率和死亡率无差异。与其他版本相比，乐队修订的停留时间与主要手术相似，并发症更少。进行胃底翻修术以绕过翻修术的患者年龄较大，之前接受过多次胃部手术，发病率最高（40％），再次手术率最高（20％）。结论：在经验丰富的手中，可以安全地完成许多减肥手术，其围手术期效果与主要手术相似。然而，随着修订程序的复杂性和先前手术数量的增加，围手术期的发病率也随之增加，胃旁路术的胃底折叠术是最高风险组。

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