Riess Kevin P, Baker Matthew T, Lambert Pamela J, Mathiason Michelle A, Kothari Shanu N
Surgery Residency, Gundersen Lutheran Medical Foundation, La Crosse, Wisconsin 54601, USA.
Surg Obes Relat Dis. 2008 Nov-Dec;4(6):704-8. doi: 10.1016/j.soard.2008.05.007. Epub 2008 Aug 16.
Requiring patients to lose weight before weight reduction surgery is controversial. The goal of this study was to determine whether preoperative weight loss affects laparoscopic Roux-en-Y gastric bypass surgery outcomes.
The medical records of all laparoscopic Roux-en-Y gastric bypass patients from September 1, 2001 to March 31, 2005 were retrospectively reviewed in our prospective database. Depending on their habitus, patients were selectively required to lose >4.54 kg (10 lb) preoperatively (WL group). Their outcomes were compared with those of the patients not required to lose weight preoperatively (no-WL group). Statistical analysis was performed with the chi-square test and Student's t test for demographic data. Student's t test was used to assess the outcome data. P <.05 was considered significant.
Of the 353 patients, 74 (21%) were in the WL group. The operative times in the WL group averaged 10 minutes longer than in the no-WL group (P = .022). The mean length of stay was not significantly different between the 2 groups. Of the 353 patients, 262 (74%) completed 1 year of follow-up. The mean net postoperative weight loss was not significantly different between the 2 groups. The no-WL patients had a greater percentage of excess postoperative weight loss than the WL group (74% versus 66%; P = .01). Net complications occurred less frequently in the WL group (P = .035).
Preoperative weight loss did not decrease the operative times or the length of stay. Preoperative weight loss increased neither the mean net postoperative weight loss nor the percentage of excess postoperative weight loss at 1-year follow-up. However, the WL group had fewer net complications.
要求患者在减重手术前减肥存在争议。本研究的目的是确定术前体重减轻是否会影响腹腔镜Roux-en-Y胃旁路手术的结果。
对2001年9月1日至2005年3月31日期间所有接受腹腔镜Roux-en-Y胃旁路手术患者的病历进行回顾性分析，这些病历来自我们的前瞻性数据库。根据患者的体型，选择性地要求患者术前减重超过4.54千克（10磅）（减重组）。将他们的结果与术前未要求减重的患者（未减重组）进行比较。对人口统计学数据进行卡方检验和学生t检验。用学生t检验评估结果数据。P<0.05被认为具有统计学意义。
353例患者中，74例（21%）在减重组。减重组的手术时间平均比未减重组长10分钟（P = 0.022）。两组的平均住院时间无显著差异。353例患者中，262例（74%）完成了1年的随访。两组术后平均净体重减轻无显著差异。未减重组术后多余体重减轻的百分比高于减重组（74%对66%；P = 0.01）。减重组净并发症发生率较低（P = 0.035）。
术前减重并未减少手术时间或住院时间。在1年随访时，术前减重既未增加术后平均净体重减轻，也未增加术后多余体重减轻的百分比。然而，减重组的净并发症较少。
