Bowel habits after bariatric surgery
Bowel habits after bariatric surgery
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DOI：
10.1007/s11695-008-9456-4
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发表时间：
2008-10-01
期刊：
影响因子：
2.9
通讯作者：
Horber, Fritz F.
中科院分区：
文献类型：
--
作者：
Potoczna, Natascha;Harfmann, Susanne;Horber, Fritz F.
排便习惯紊乱可能影响减肥手术后的生活质量。不同类型的减肥手术-胃束带术（AGB），Roux-en-Y胃旁路术（RYGB）或胆胰分流术（BPD）-可能会改变肠道习惯，作为所使用的外科手术的结果。排便习惯的改变是否会影响AGB、RYGB或BPD后的生活质量尚不清楚。方法研究组包括1996年8月至2004年9月期间接受减肥手术的290例严重肥胖患者[BPD：n=103，64.1%为女性，年龄43 +/- 1岁（平均值+/- SEM），BMI 53.9 +/- 0.9 kg/m2，体重153.4 +/- 2.9 kg; Roux-en-Y胃旁路术：n=126，73.0%为女性，年龄43 ± 1岁，BMI 44.2 ± 0.3 kg/m2，体重123.8 ± 1.5 kg;可调节胃束带术（AGB）：n=61，57.4%为女性，年龄44 ± 1岁，BMI 49.9 ± 0.5 kg/m2，体重146.1 ± 2.0 kg）。术后至少4个月，通过自填问卷评估排便习惯、肠胃气胀、肠胃气胀气味和对社会生活的影响的变化。稀便和腹泻在BPD和RYGB后发生率更高（P < 0.001），但BPD后更高（P < 0.002）。AGB后更可能发生并发症（P=0.03）。此外，影响社会生活的恶臭排气在BPD后比RYGB或AGB后更频繁（P < 0.003）。BPD和RYGB术后患者的肛门排气次数增加，且患者对肛门排气恶臭的困扰程度高于AGB（均P < 0.001）。BPD患者的肠胃气胀严重程度评分最高，RYGB患者居中，AGB患者最低（均P < 0.001），手术前后代谢综合征的频率对差异无影响。此外，术后观察期对排便习惯的总体结果没有影响。所有三组的生活质量肥胖分析和报告结果系统（BAROS）评分基本相似。然而，在BPD和RYGB中，胃肠气胀严重程度评分与BAROS评估的生活质量呈负相关，但在AGB患者中则不然。减肥手术的类型以手术特异性方式影响排便习惯，主要导致BPD和RYGB后腹泻，AGB后便秘。在BPD中，胃肠胀气严重程度对生活质量的影响最大，在RYGB中居中，在AGB后仅为轻微，这一现象仅部分反映在BAROS的生活质量测量中。
Background Disordered bowel habits might influence quality of life after bariatric surgery. Different types of bariatric operations-gastric banding (AGB), Roux-en-Y gastric bypass (RYGB), or biliopancreatic diversion (BPD)-might alter bowel habits as a consequence of the surgical procedure used. Whether change in bowel habits affects quality of life after AGB, RYGB, or BPD differently is unknown.Methods The study group contained 290 severely obese patients undergoing bariatric surgery between August 1996 and September 2004 [BPD: n=103, 64.1% women, age 43 +/- 1 years (mean +/- SEM), BMI 53.9 +/- 0.9 kg/m(2), weight 153.4 +/- 2.9 kg; Roux-en-Y gastric bypass: n=126, 73.0% women, age 43 +/- 1 years, BMI 44.2 +/- 0.3 kg/m(2), weight 123.8 +/- 1.5 kg; adjustable gastric banding (AGB): n=61, 57.4% women, age 44 +/- 1 years, BMI 49.9 +/- 0.5 kg/m(2),weight 146.1 +/- 2.0 kg). Changes in bowel habits, flatulence, flatus odor, and effects on social life were estimated at least 4 months after surgery using a self-administered questionnaire.Fecal consistency changed significantly after surgery. Loose stools and diarrhea were more frequent after BPD and RYGB (P < 0.001) but more so after BPD than after either RYGB or AGB (P < 0.002). Constipation was more likely after AGB (P=0.03). In addition, malodorous flatus affecting social life was more frequent after BPD than after either RYGB or AGB (P < 0.003). Furthermore, flatus frequency increased after BPD and RYGB, and patients were more bothered by their malodorous flatus than after AGB (all P < 0.001). Flatus severity score was highest in BPD, intermediate in RYGB, and lowest in AGB patients (all P < 0.001), a difference that was not influenced by frequency of metabolic syndrome before and after surgery. Moreover, observation period after surgery had no influence on overall results of bowel habits. Subsore quality of life bariatric analysis and reporting outcome system (BAROS) scores were largely similar between all three groups. However, flatulence severity score correlated inversely with quality of life estimated by BAROS in BPD and RYGB, but not in AGB patients.The type of bariatric surgery affects bowel habits in an operation-specific manner, resulting mainly in diarrhea after BPD and RYGB, and constipation after AGB. Flatulence severity impairs quality of life most in BPD, is intermediate in RYGB, and is only minor after AGB, a phenomenon that was only partially mirrored in quality-of-life measures of BAROS.