Müller M K, Räder S, Wildi S, Hauser R, Clavien P-A, Weber M
Department of Visceral and Transplant Surgery, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland.
Br J Surg. 2008 Nov;95(11):1375-9. doi: 10.1002/bjs.6297.
Laparoscopic gastric bypass is the 'gold standard' for treatment of morbidly obese patients in many centres. There is debate regarding the optimal length for small bowel limbs. This study aimed to determine whether the proximal or distal approach is better.
Twenty-five patients undergoing primary distal gastric bypass in 2000-2002 were randomly matched for age, sex and preoperative body mass index (BMI) with 25 patients having a primary proximal bypass. All distal operations were performed laparoscopically; one proximal procedure was converted to open surgery.
Mean operating time was 170 min for proximal and 242 min for distal bypasses (P = 0.004); median hospital stay was similar in the two groups. There were no deaths and the overall complication rate was similar, as was weight loss at 4 years: BMI decreased from 45.9 to 31.7 kg/m2 for the proximal and from 45.8 to 33.1 kg/m2 for the distal approach. Co-morbidities decreased after surgery in both groups; the prevalence of diabetes, arterial hypertension and dyslipidaemia at all time points was similar in the two groups.
Proximal and distal laparoscopic gastric bypass operations are feasible and safe, with no differences in weight loss or reduction of co-morbidity in unselected morbidly obese patients.
在许多中心，腹腔镜胃旁路手术是治疗病态肥胖患者的“金标准”。关于小肠袢的最佳长度存在争议。本研究旨在确定近端入路还是远端入路更好。
将2000 - 2002年接受初次远端胃旁路手术的25例患者，按年龄、性别和术前体重指数（BMI）与25例接受初次近端胃旁路手术的患者进行随机匹配。所有远端手术均通过腹腔镜进行；1例近端手术转为开放手术。
近端胃旁路手术的平均手术时间为170分钟，远端为242分钟（P = 0.004）；两组的中位住院时间相似。无死亡病例，总体并发症发生率相似，4年时的体重减轻情况也相似：近端入路组的BMI从45.9降至31.7kg/m²，远端入路组从45.8降至33.1kg/m²。两组术后合并症均减少；两组在所有时间点糖尿病、动脉高血压和血脂异常的患病率相似。
近端和远端腹腔镜胃旁路手术都是可行且安全的，在未经选择的病态肥胖患者中，体重减轻或合并症减少方面无差异。
