Obesity Surgery Results Depending on Technique Performed: Long-Term Outcome
Obesity Surgery Results Depending on Technique Performed: Long-Term Outcome
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DOI：
10.1007/s11695-008-9762-x
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发表时间：
2009-04-01
期刊：
影响因子：
2.9
通讯作者：
Arribas, D.
中科院分区：
文献类型：
--
作者：
Gracia, J. A.;Martinez, M.;Arribas, D.
许多技术在2年的随访中取得了很好的效果，但关于其长期疗效的一些问题已经出现。这就是为什么减肥手术的结果必须在长期随访中分析的原因。这项研究的目的是将分析扩展到5年以上，评估手术的体重减轻、发病率和死亡率。这是一项对我们病态肥胖科实施的不同病态肥胖手术的回顾性队列研究。根据体重减轻、并发症改善和术后并发症发生率(体重分析和报告结果系统)进行分析。125例患者接受了开放垂直捆绑胃成形术(VBG)，150例接受了Scope inaro的开放胆胰管转流术(BPD)，100例接受了改良开放BPD(共同肢体75 cm；消化道肢体225 cm)，115例患者接受了腹腔镜Roux-en-Y胃搭桥术(LRYGBP)。平均随访时间：VBG 12年，BPD 7年，LRYGBP 4年。所有技术在第二年随访结束时均观察到良好的初始体重下降，但VBG组和LRYGBP组的体重从这一时间开始出现重要的恢复。到目前为止，只有BPD组保持了良好的体重成绩。病死率：VBG为1.6%，BPD为1.2%，LRYGBP为0%。术后早期并发症：VBG 25%，BPD 20.4%，LRYGBP 20%。术后远期并发症：蛋白营养不良：VBG组为11%，改良BPD组为3%，VBG组和LRYGBP组均无病例报告；缺铁症VBG组为20%，Scopinaro BPD组为62%，改良BPD组为40%，LRYGBP组为30.5%。14.5%的VBG组因100%体重恢复或呕吐而需行胃旁路翻修手术或BPD。3.2%患有严重蛋白质营养不良的Scopinaro BPD需要进行翻修手术，将共同肢体延长到100厘米。0.8%的LRYGBP需要对LRYGBP远端(共同肢体75厘米)进行翻修手术，因为100%的体重恢复。最复杂的减肥程序增加了疗效，但不幸的是，它们也增加了发病率和死亡率。LRYGBP治疗病态肥胖症安全有效。改良的BPD(75-225厘米)可考虑用于治疗超重肥胖症(BMI；50 kg/m(2))，由于长期随访失败率较高，应仅在精心挑选的患者中进行限制性手术，如VBG。
Many techniques have excellent results at 2 years of follow-up but some matters regarding their long-term efficacy have arisen. This is why bariatric surgery results must be analyzed in long-term follow-up. The aim of this study was to extend the analysis over 5 years, evaluating weight loss, morbidity, and mortality of the surgical procedures performed.This was a retrospective cohort study of the different procedures for morbid obesity practiced in our Department of Surgery for morbid obesity. The results have been analyzed in terms of weight loss, morbidity improvement, and postoperative morbidity (Bariatric Analysis And Reporting Outcome System).One hundred twenty-five patients were operated on open vertical banded gastroplasty (VBG), 150 patients of open biliopancreatic diversion (BPD) of Scopinaro, 100 patients of open modified BPD (common limb 75 cm; alimentary limb 225 cm), and 115 patients of laparoscopic Roux-en-Y gastric bypass (LRYGBP). Mean follow-up was: VBG 12 years, BPD 7 years, and LRYGBP 4 years. An excellent initial weight loss was observed at the end of the second year of follow-up in all techniques, but from this time an important regain of weight was observed in VBG group and a discrete weight regain in LRYGBP group. Only BPD groups kept excellent weight results so far in time. Mortality was: VBG 1.6%, BPD 1.2%, and LRYGBP 0%. Early postoperative complications were: VBG 25%, BPD 20.4%, and LRYGBP 20%. Late postoperative morbidity was: protein malnutrition 11% in Scopinaro BPD, 3% in Modified BPD group, and no cases reported either in VBG group or LRYGBP group; iron deficiency 20% VBG, 62% Scopinaro BPD, 40% modified BPD, and 30.5% LRYGBP. A 14.5% of VBG group required revision surgery to gastric bypass or to BPD due to 100% weight regain or vomiting. A 3.2% of Scopinaro BPD with severe protein malnutrition required revision surgery to lengthen common limb to 100 cm. A 0.8% of LRYGBP required revision surgery to distal LRYGBP (common limb 75 cm) due to 100% weight regain.The most complex bariatric procedures increase the effectiveness but unfortunately they also increase morbidity and mortality. LRYGBP is safe and effective for the treatment of morbid obesity. Modified BPD (75-225 cm) can be considered for the treatment of superobesity (body mass index > 50 kg/m(2)), and restrictive procedures such as VBG should only be performed in well-selected patients due to high rates of failure in long-term follow-up.