Harnisch Michael C, Portenier Dana D, Pryor Aurora D, Prince-Petersen Rebecca, Grant John P, DeMaria Eric J
Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
Surg Obes Relat Dis. 2008 May-Jun;4(3):445-50. doi: 10.1016/j.soard.2007.09.016.
Success with preoperative weight loss (PWL) is often mandated by the bariatric team to assess patient compliance and has been suggested to correlate with improved postoperative weight loss outcomes.
We performed a retrospective analysis of 1629 consecutive patients undergoing laparoscopic Roux-en-Y gastric bypass at Duke University Medical Center. Patients with a preoperative weight gain (PWG) or loss of > or =10 lb were compared. Patients with <12 months of follow-up were excluded.
We found no difference between the 2 groups (PWG, n = 115, PWL, n = 88) with regard to age, gender, race, preoperative body mass index, presence of co-morbidities, or interval between the initial program-entry weight and surgery (149 versus 141 d). No difference was found in the percentage of excess weight loss (EWL) at 12 months, when calculated using the patient's immediate preoperative weight (PWG group, 63.5% EWL versus PWL group, 63.9% EWL, P = NS). If the %EWL was calculated using the initial program-entry weight, the PWL did confer a transient postoperative weight loss advantage; however, this did not persist past 24 months postoperatively. At both 12 and 24 months, the resolution rates of diabetes (82% versus 83% at 2 yr; P = NS), hypertension (48% versus 42% at 2 yr, P = NS), and continuous positive airway pressure discontinuation (87% versus 87% at 1 yr, P = NS) were equivalent. No differences in perioperative complications or conversion rates were detected. The operative time was slightly longer for the PWG group (119.7 versus 104.9 min, P = .02).
The results of our study have shown that weight loss before laparoscopic Roux-en-Y gastric bypass is not mandatory and might deter patients from considering weight loss surgery. Laparoscopic Roux-en-Y gastric bypass can be performed safely with equivalent co-morbidity resolution and %EWL regardless of PWG or PWL.
减肥手术团队通常要求术前减肥（PWL）取得成功，以评估患者的依从性，并且有人认为这与术后减肥效果的改善相关。
我们对杜克大学医学中心连续接受腹腔镜Roux-en-Y胃旁路手术的1629例患者进行了回顾性分析。比较术前体重增加（PWG）或体重减轻≥10磅的患者。排除随访时间<12个月的患者。
我们发现两组（PWG组，n = 115；PWL组，n = 88）在年龄、性别、种族、术前体重指数、合并症的存在情况或初始入组体重与手术之间的间隔时间（149天对141天）方面没有差异。使用患者术前即刻体重计算时，12个月时的超重减轻百分比（EWL）没有差异（PWG组，EWL为63.5%；PWL组，EWL为63.9%，P =无统计学意义）。如果使用初始入组体重计算EWL百分比，PWL确实在术后短期内具有减肥优势；然而，这种优势在术后24个月后并未持续。在12个月和24个月时，糖尿病的缓解率（2年时分别为82%对83%；P =无统计学意义）、高血压的缓解率（2年时分别为48%对42%，P =无统计学意义）以及持续气道正压通气停用率（第1年时分别为87%对87%，P =无统计学意义）相当。未检测到围手术期并发症或转换率的差异。PWG组的手术时间略长（119.7分钟对104.9分钟，P = 0.02）。
我们的研究结果表明，腹腔镜Roux-en-Y胃旁路手术前减肥并非必需，而且可能会阻碍患者考虑减肥手术。无论术前体重增加或减轻情况如何，腹腔镜Roux-en-Y胃旁路手术都可以安全进行，合并症缓解率和EWL百分比相当。
