Luján Juan A, Frutos M Dolores, Hernández Quiteria, Liron Ramón, Cuenca Jose R, Valero Graciela, Parrilla Pascual
Departamento de Cirugía General, Hospital Universitario Virgen de la Arrixaca, 30120 El Palmar, Murcia, Spain.
Ann Surg. 2004 Apr;239(4):433-7. doi: 10.1097/01.sla.0000120071.75691.1f.
The objective of the study was to compare the results of open versus laparoscopic gastric bypass in the treatment of morbid obesity.
Gastric bypass is one of the most commonly acknowledged surgical techniques for the management of morbid obesity. It is usually performed as an open surgery procedure, although now some groups perform it via the laparoscopic approach.
Between June 1999 and January 2002 we conducted a randomized prospective study in 104 patients diagnosed with morbid obesity. The patients were divided into 2 groups: 1 group with gastric bypass via the open approach (OGBP) comprising 51 patients, and 1 group with gastric bypass via the laparoscopic approach (LGBP) comprising 53 patients. The parameters compared were as follows: operating time, intraoperative complications, early (<30 days) and late (>30 days) postoperative complications, hospital stay, and short-term evolution of body mass index.
Mean operating time was 186.4 minutes (125-290) in the LGBP group and 201.7 minutes (129-310) in the OGBP group (P < 0.05). Conversion to laparotomy was necessary in 8% of the LGBP patients. Early postoperative complications (<30 days) occurred in 22.6% of the LGBP group compared with 29.4% of the OGBP group, with no significant differences. Late complications (>30 days) occurred in 11% of the LGBP group compared with 24% of the OGBP group (P < 0.05). The differences observed between the 2 groups are the result of a high incidence of abdominal wall hernias in the OGBP group. Mean hospital stay was 5.2 days (1-13) in the LGBP group and 7.9 days (2-28) in the OGBP group (P < 0.05). Evolution of body mass index during a mean follow-up of 23 months was similar in both groups.
LGBP is a good surgical technique for the management of morbid obesity and has clear advantages over OGBP, such as a reduction in abdominal wall complications and a shorter hospital stay. The midterm weight loss is similar with both techniques. One inconvenience is that LGBP has a more complex learning curve than other advanced laparoscopic techniques, which may be associated with an increase in postoperative complications.
本研究的目的是比较开放式与腹腔镜胃旁路手术治疗病态肥胖症的效果。
胃旁路手术是治疗病态肥胖症最常用的公认外科技术之一。它通常作为开放手术进行，尽管现在一些团队通过腹腔镜方法进行。
1999年6月至2002年1月期间，我们对104例被诊断为病态肥胖症的患者进行了一项随机前瞻性研究。患者分为2组：1组采用开放式胃旁路手术（OGBP），共51例患者；1组采用腹腔镜胃旁路手术（LGBP），共53例患者。比较的参数如下：手术时间、术中并发症、术后早期（<30天）和晚期（>30天）并发症、住院时间以及体重指数的短期变化。
LGBP组的平均手术时间为186.4分钟（125 - 290分钟），OGBP组为201.7分钟（129 - 310分钟）（P < 0.05）。8%的LGBP患者需要转为开腹手术。LGBP组术后早期并发症（<30天）发生率为22.6%，OGBP组为29.4%，无显著差异。LGBP组晚期并发症（>30天）发生率为11%，OGBP组为24%（P < 0.05）。两组之间观察到的差异是由于OGBP组腹壁疝发生率较高。LGBP组的平均住院时间为5.2天（1 - 13天），OGBP组为7.9天（2 - 28天）（P < 0.05）。两组在平均随访23个月期间体重指数的变化相似。
LGBP是治疗病态肥胖症的一种良好外科技术，与OGBP相比具有明显优势，如腹壁并发症减少和住院时间缩短。两种技术的中期体重减轻相似。一个不便之处是，LGBP的学习曲线比其他先进的腹腔镜技术更复杂，这可能与术后并发症增加有关。
