因反流和体重复发而进行袖状胃切除术后翻修手术的全国趋势：一项配对病例对照分析。
National trends in using revisional surgeries post-sleeve gastrectomy due to reflux and weight recurrence: a matched case-control analysis.
作者信息
Shin Thomas H, Medhati Pourya, Mathur Vasundhara, Nimeri Abdelrahman, Sheu Eric G, Tavakkoli Ali
机构信息
Laboratory for Surgical and Metabolic Research, Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of General Surgery, Department of Surgery, University of Virginia, Charlottesville, Virginia.
Laboratory for Surgical and Metabolic Research, Division of General and Gastrointestinal Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.
出版信息
Surg Obes Relat Dis. 2025 Mar;21(3):240-246. doi: 10.1016/j.soard.2024.09.011. Epub 2024 Oct 9.
BACKGROUND
Several options exist for surgical conversion after sleeve gastrectomy (SG), but a definitive safety profile for each option by indication for conversion remains unclear.
OBJECTIVES
To determine and compare 30-day risk profiles of SG conversion to Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), and single-anastomosis duodenoileostomy (SADI).
METHODS
Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program national database entries from 2020 to 2022 were used to identify 25,760 adult patients who underwent SG conversion to RYGB, BPD-DS, or SADI. Subgroup analyses were performed among 6106 conversions completed for weight-related complications (RYGB: 3053 patients; BPD-DS: 1826 patients; SADI: 1227 patients). Multivariable analysis and 1:1 nearest-neighbor matching were used to further characterize the 30-day risk profile of each conversion.
RESULTS
Patients with RYGB conversions had a lower preoperative body mass index compared with those with BPD-DS + SADI conversions (39.8 versus 46.1, P < .001) and significantly lower rates of medical comorbidities. The distribution of conversion indication for each MBS configuration varied, where most RYGB conversions were for reflux (56.1%) whereas most BPD-DS + SADI conversions were for weight-related complications (87.3%; P < .001). On 1:1 matched analysis of conversions for weight recurrence, odds of 30-day complications (odds ratio .73, P = .019) and readmission (odds ratio .77, P = .031) were lower in BPD-DS + SADI conversions compared with RYGB. There were no significant differences in odds of 30-day reintervention or reoperation between conversion to RYGB and BPD-DS + SADI. Major differing drivers of complications between conversion types included hemorrhage (RYGB 1.98% versus BPD-DS + SADI .87%; P = .001).
CONCLUSIONS
For weight recurrence after SG, conversion to BPD-DS + SADI does not have greater 30-day complications than RYGB and may be a safe conversion option.
背景
袖状胃切除术后（SG）有多种手术转换方案，但每种转换方案的确切安全性仍不明确。
目的
确定并比较SG转换为Roux-en-Y胃旁路术（RYGB）、胆胰分流十二指肠转位术（BPD-DS）和单吻合十二指肠回肠旁路术（SADI）的30天风险概况。
方法
利用2020年至2022年代谢与减重手术认证及质量改进计划的国家数据库条目，识别25760例接受SG转换为RYGB、BPD-DS或SADI的成年患者。对因体重相关并发症完成的6106例转换进行亚组分析（RYGB：3053例患者；BPD-DS：1826例患者；SADI：1227例患者）。采用多变量分析和1:1最近邻匹配进一步描述每种转换的30天风险概况。
结果
与BPD-DS + SADI转换患者相比，RYGB转换患者术前体重指数较低（39.8对46.1，P <.001），合并症发生率显著较低。每种代谢减重手术配置的转换指征分布不同，大多数RYGB转换是因为反流（56.1%），而大多数BPD-DS + SADI转换是因为体重相关并发症（87.3%；P <.001）。在对体重复发的转换进行1:1匹配分析时，BPD-DS + SADI转换的30天并发症发生率（比值比0.73，P = 0.019）和再入院率（比值比0.77，P = 0.031）低于RYGB。RYGB转换和BPD-DS + SADI转换之间的30天再次干预或再次手术发生率无显著差异。不同转换类型并发症的主要不同驱动因素包括出血（RYGB为1.98%对BPD-DS + SADI为0.87%；P = 0.001）。
结论
对于SG术后体重复发，转换为BPD-DS + SADI的30天并发症并不比RYGB多，可能是一种安全的转换选择。
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