نتايج و عوارض ديررس جراحي باي‌پس Roux-en-Y معده به‌روش باز در چاقي مرضي: گزارش كوتاه

Long-term results of open gastric bypass with Roux-en-Y method for morbid obesity: brief report

زمينه و هدف: مداخله جراحی روشی است كه باعث كاهش وزن، بهبود بيماری‌های مرتبط با چاقی مرضی و افزايش كيفيت زندگی بيماران مبتلا به چاقی مرضی می‌گردد. اين مطالعه با هدف بررسی نتايج و عوارض ديررس جراحی بای‌پس Roux-en-Y معده به‌روش باز در درمان چاقی مرضی انجام گرديد. روش بررسی: مطالعه به‌روش توصيفی در 39 بيماری كه به‌منظور درمان چاقی مرضی در مدت زمان 15 سال (ارديبهشت 1376 تا ارديبهشت 1391) در بيمارستان قائم (عج) شهر مشهد تحت جراحی بای‌پس Roux-en-Y معده به‌روش باز قرار گرفته بودند انجام شد. يافته‌ها: دوره پيگيری بيماران 180-6 ماه (متوسط 100 ماه) پس از جراحی بود. عوارض ديررس شامل يك مورد كوله ليتياز، دو مورد تنگی گاستروژژنوستومی، سه مورد آنمی فقر آهن و يك مورد بيماری ورنيكه بود. يك مورد فوت به‌علت بيماری ورنيكه 14 ماه پس از عمل جراحی وجود داشت. نتيجه‌گيری: با توجه به نتايج مطالعه، روش باز جراحی بای‌پس Roux-en-Y معده، روش موثر با عوارض اندك در درمان چاقی مرضی می‌باشد.

Background: This study aims to evaluate the outcomes and late complications of open Roux-en-Y gastric bypass surgery in the treatment of morbid obesity. Methods: Over a 15 year-period between May 1997 and May 2012, we reviewed our experiments with 39 patients who underwent open gastric bypass for morbid obesity. The weight of the patient and surgical complications were recorded. Ideal weight, body mass index, weight loss and excess weight loss were calculated. Results: The follow up period ranged from 6 to 180 months with a mean of 100 months after operation. Average weight loss was 3.9 and 0.28 kg per month during the first and second years after operation weight loss was slower from the third year on-wards. Weight loss generally was stabilized between 12 and 18 months after operation. Only one patient (2.6%) had a weight loss failure criterion. Concomitant condition ex-isted in 14 patients (48.2%) of our series. These included hypertension in 3 cases (10.3%) that was resolved in 100%, diabetes mellitus in 4 (13.7%) that was resolved in 75%, cholelithiasis in 7 cases (24.1%) that was resolved by cholecystectomy during the operation. There was no early postoperative death. Early complications occurred in 2 patients (5.1%), including pulmonary embolism (2.6%) and gastrointestinal bleeding (2.6%). The late complications occurred in 7 patients (17.9%) involved 2 patients with anastomotic stricture at the gastrojejunostomy (5.1%), One patient with symptomatic cholelithiasis (2.6%), three patient with anemia (7.7%), and one patient had Wernicke ’s disease who died of this complication (2.6%). Conclusion: The results of the study showed that the open Roux-en-Y gastric bypass surgery is an effective procedure in the treatment of morbid obesity with minimal late complications.