A case report of laparoscopic narrow and long pouch Roux-en-Y gastric bypass surgery for the treatment of severe obesity

doi:10.3877/cma.j.issn.2095-9605.2023.03.013

Abstract

Abstract:

Laparoscopic Roux-en-Y gastric bypass surgery (LRYGB) is one of the most performed bariatric procedures. After LRYGB surgery, various complications are associated with dilation of the gastric pouch and gastrointestinal anastomosis. In 2016, based on summarizing relevant experience, the author's team innovated the operation and created a new surgical method: narrow and long pouch Roux-en-Y gastric bypass (NLP-RYGB), hereinafter referred to as NLP-RYGB. This article reports the main steps of this procedure in a patient with a BMI of 43.1 kg/m², the preliminary effect after surgery, and the discussion of this procedure. This patient is the first case in China to report NLP-RYGB postoperative follow-up of up to 7 years, which has certain reference value for evaluating the effect of this procedure.

Key words: Narrow and long gastric pouch, Laparoscopic Roux-en-Y gastric bypass, Severe obesity, Type 2 diabetes mellitus

Wei You, Zhuoqi Wei, Wenhui Chen, Zhiyong Dong, Wah Yang, Cunchuan Wang. A case report of laparoscopic narrow and long pouch Roux-en-Y gastric bypass surgery for the treatment of severe obesity[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(03): 218-223.

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References 16

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项目	类别	术前	术后1个月	术后3个月	术后6个月	术后1年	术后2年	术后3年	术后5年
血常规	白细胞计数/*10⁹	8.0	5.1	5.5	6.4	6.4	5.1	5.9	5.7
	血红蛋白/（g/L）	139.0	150.6	133.0	123.0	96.2	94.0	84.0	96.0
	红细胞压积/（%）	43.7	47.7	41.1	39.6	32.4	31.7	29.0	33.2
生化指标	尿酸/（umol/L）	347.0	635.0	386.7	299.5	331.6	393.3	281.0	359.0
	铁/（umol/L）	14.3	16.1	16.7	16.2	4.6	4.6	3.1	4.4
	丙氨酸氨基转换酶/（U/L）	97.0	52.0	34.1	15.4	12.8	13.0	12.0	15.0
	门冬氨酸氨基转移酶/（U/L）	56.0	46.0	32.1	20.1	19.9	19.0	18.0	19.0
	总胆固醇/（mmol/L）	4.8	4.2	4.8	4.2	4.1	4.4	4.0	4.3
	甘油三酯/（mmol/L）	2.2	1.4	1.8	0.9	0.9	1.0	1.0	0.9
	白蛋白/（g/L）	42.5	46.4	41.2	43.6	42.3	43.4	45.3	42.2
	高密度脂蛋白/（mmol/L）	1.2	0.9	1.0	1.3	1.5	1.5	1.5	1.4
	低密度脂蛋白/（mmol/L）	2.9	2.4	3.1	2.5	2.6	2.4	2.0	2.0
	载脂蛋白B/（g/L）	0.9	0.9	0.9	0.7	0.7	0.8	0.6	0.7
	脂蛋白a/（mg/L）	21.0	21.0	15.5	20.7	16.8	26.7	25.2	28.0
血糖指标	C肽/（ng/ml）	4.3	2.2	2.0	1.9	1.4	1.8	0.1	1.4
	胰岛素/（mIU/L）	35.1	10.1	8.2	10.5	5.4	7.2	4.8	5.7
	糖化血红蛋白/（%）	5.9	5.2	5.3	5.5	5.5	5.6	5.7	5.7
	葡萄糖/（mmol/L）	6.1	4.3	4.7	5.2	5.5	5.2	5.0	4.6
营养指标	25-OH维生素D/（ng/ml）	13.3	16.0	18.2	18.5	21.5	19.6	17.6	18.6
	叶酸/（ng/ml）	17.6	11.3	—	9.7	20.3	23.8	>23.6	18.7
	维生素B₁₂/（pg/ml）	693.0	1154.0	—	—	184.6	—	139.8	90.2
	铁蛋白/（ng/mL）	97.6	101.1	19.9	4.4	2.8	3.1	1.7	3.9
	维生素A/（nmol/L）	1.3	—	1.6	1.3	0.9	1.5	1.9	1.7
	维生素B₁/（ng/L）	47.6	—	83.1	75.8	88.8	120.6	68.5	73.4
	维生素B₂/（ng/mL）	419.6	—	37.8	298.9	461.1	209.6	220.7	271.6
	维生素B₆/（nmol/L）	40.2	—	20.4	14.7	11.5	54.1	47.7	40.5
	维生素C/（nmol/L）	39.6	—	35.6	32.2	44.7	66.9	60.5	57.6
	维生素E/（ng/L）	10.4	—	11.2	10.6	11.9	12.6	11.4	14.1

项目	类别	术前	术后1个月	术后3个月	术后6个月	术后1年	术后2年	术后3年	术后5年
血常规	白细胞计数/*10⁹	8.0	5.1	5.5	6.4	6.4	5.1	5.9	5.7
	血红蛋白/（g/L）	139.0	150.6	133.0	123.0	96.2	94.0	84.0	96.0
	红细胞压积/（%）	43.7	47.7	41.1	39.6	32.4	31.7	29.0	33.2
生化指标	尿酸/（umol/L）	347.0	635.0	386.7	299.5	331.6	393.3	281.0	359.0
	铁/（umol/L）	14.3	16.1	16.7	16.2	4.6	4.6	3.1	4.4
	丙氨酸氨基转换酶/（U/L）	97.0	52.0	34.1	15.4	12.8	13.0	12.0	15.0
	门冬氨酸氨基转移酶/（U/L）	56.0	46.0	32.1	20.1	19.9	19.0	18.0	19.0
	总胆固醇/（mmol/L）	4.8	4.2	4.8	4.2	4.1	4.4	4.0	4.3
	甘油三酯/（mmol/L）	2.2	1.4	1.8	0.9	0.9	1.0	1.0	0.9
	白蛋白/（g/L）	42.5	46.4	41.2	43.6	42.3	43.4	45.3	42.2
	高密度脂蛋白/（mmol/L）	1.2	0.9	1.0	1.3	1.5	1.5	1.5	1.4
	低密度脂蛋白/（mmol/L）	2.9	2.4	3.1	2.5	2.6	2.4	2.0	2.0
	载脂蛋白B/（g/L）	0.9	0.9	0.9	0.7	0.7	0.8	0.6	0.7
	脂蛋白a/（mg/L）	21.0	21.0	15.5	20.7	16.8	26.7	25.2	28.0
血糖指标	C肽/（ng/ml）	4.3	2.2	2.0	1.9	1.4	1.8	0.1	1.4
	胰岛素/（mIU/L）	35.1	10.1	8.2	10.5	5.4	7.2	4.8	5.7
	糖化血红蛋白/（%）	5.9	5.2	5.3	5.5	5.5	5.6	5.7	5.7
	葡萄糖/（mmol/L）	6.1	4.3	4.7	5.2	5.5	5.2	5.0	4.6
营养指标	25-OH维生素D/（ng/ml）	13.3	16.0	18.2	18.5	21.5	19.6	17.6	18.6
	叶酸/（ng/ml）	17.6	11.3	—	9.7	20.3	23.8	>23.6	18.7
	维生素B₁₂/（pg/ml）	693.0	1154.0	—	—	184.6	—	139.8	90.2
	铁蛋白/（ng/mL）	97.6	101.1	19.9	4.4	2.8	3.1	1.7	3.9
	维生素A/（nmol/L）	1.3	—	1.6	1.3	0.9	1.5	1.9	1.7
	维生素B₁/（ng/L）	47.6	—	83.1	75.8	88.8	120.6	68.5	73.4
	维生素B₂/（ng/mL）	419.6	—	37.8	298.9	461.1	209.6	220.7	271.6
	维生素B₆/（nmol/L）	40.2	—	20.4	14.7	11.5	54.1	47.7	40.5
	维生素C/（nmol/L）	39.6	—	35.6	32.2	44.7	66.9	60.5	57.6
	维生素E/（ng/L）	10.4	—	11.2	10.6	11.9	12.6	11.4	14.1

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