WEIGHT-LOSS AND DIETARY-INTAKE AFTER VERTICAL BANDED GASTROPLASTY AND ROUX-EN-Y GASTRIC BYPASS
WEIGHT-LOSS AND DIETARY-INTAKE AFTER VERTICAL BANDED GASTROPLASTY AND ROUX-EN-Y GASTRIC BYPASS
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DOI：
10.1097/00000658-199412000-00012
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发表时间：
1994-12-01
影响因子：
9
通讯作者：
CODY, RP
中科院分区：
文献类型：
--
作者：
BROLIN, RE;ROBERTSON, LB;CODY, RP
目的本研究的目的是了解术前饮食习惯是否可以用来预测垂直带状胃成形术（VBG）和Roux-en-Y胃旁路术（RYGB.Background Summary）后的结果几个独立的随机和连续的研究报告RYGB后的体重减轻明显大于VBG。虽然这两个程序后负责减肥的机制是限制摄入量，而不是吸收不良，热量摄入量，食物偏好，术后体重减轻之间的关系没有很好地defined.Methods在过去的5年中，138例患者被前瞻性地选择为VBG或RYGB，根据他们的术前饮食习惯。所有患者均由营养师进行筛选，在推荐VBG或RYGB之前确定总卡路里摄入量和饮食组成。30名患者被选为VBG;其余108名患者被归类为“甜食者”或“零食者”，并患有RYGB。结果VBG术后早期并发症发生率为0，RYGB术后早期并发症发生率为3%。无死亡病例。平均随访时间为VBG后39 ± 11个月和RYGB后38 ± 14个月。平均体重减轻在VBG后12个月达到峰值74 +/- 23 lb，在RYGB后16个月达到峰值99 +/- 24 lb（p ≤ 0.001）。30名VBG患者中有12名患者的多余体重减轻≥ 50%，而108名RYGB患者中有100名患者的多余体重减轻≥ 50%（p ≤ 0.0001）。6个月后，接受VBG的患者术后的牛奶/冰淇淋摄入量显着高于接受RYGB的患者（p小于或等于0.003），而在术后前18个月内，接受VBG的患者术后的固体糖果摄入量显着增加（p小于或等于0.004）。30例患者中有6例（20%）因并发症或体重减轻不佳而进行了VBG翻修，而108例接受RYGB的患者中只有2例需要手术翻修（p小于或等于0.001）。结论这些数据表明，VBG不利地改变了术后进食软、高热量食物的行为，导致术后体重减轻问题。相反，RYGB患者尽管术前饮食习惯较差，但体重减轻明显更大。手术翻修率高，加上术后体重减轻不一致，导致我们不再推荐VBG作为病态肥胖的治疗方法。
Objective The purpose of this study was to learn whether preoperative eating habits can be used to predict outcome after vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB).Background Summary Several independent randomized and sequential studies have reported significantly greater weight loss after RYGB in comparison with VBG. Although the mechanism responsible for weight loss after both procedures is restriction of intake rather than malabsorption, the relationships between calorie intake, food preferences, and postoperative weight loss are not well defined.Methods During the past 5 years, 138 patients were prospectively selected for either VBG or RYGB, based on their preoperative eating habits. All patients were screened by a dietitian who determined total calorie intake and diet composition before recommending VBG or RYGB. Thirty patients were selected for VBG; the remaining 108 patients were classified as ''sweets eaters'' or ''snackers'' and had RYGB. Detailed recall diet histories also were performed at each postoperative visit.Results Early morbidity rate was zero after VBG versus 3% after RYGB. There were no deaths. Mean follow-up was 39 +/- 11 months after VBG and 38 +/- 14 months after RYGB. Mean weight loss peaked at 74 +/- 23 lb at 12 months after VBG and 99 +/- 24 lb at 16 months after RYGB (p less than or equal to 0.001). Twelve of 30 VBG patients lost greater than or equal to 50% of their excess weight versus 100 of 108 RYGB patients (p less than or equal to 0.0001). Milk/ice cream intake was significantly greater postoperatively in patients who underwent VBG versus patients who underwent RYGB after 6 months (p less than or equal to 0.003), whereas solid sweets intake was significantly greater after VBG during the first 18 months postoperatively (p less than or equal to 0.004). Revision of VBG was performed in 6 of 30 patients (20%) for complications or poor weight loss, whereas only 2 of 108 patients who underwent RYGB required surgical revisions (p less than or equal to 0.001).Conclusions These data show that VBG adversely alters postoperative eating behavior toward soft, high-calorie foods, resulting in problematic postoperative weight loss. Conversely, RYGB patients had significantly greater weight loss despite inferior preoperative eating habits. The high rate of surgical revision in conjunction with inconsistent postoperative weight loss has led us to no longer recommend VBG as treatment for morbid obesity.