Gracia J A, Martínez M, Elia M, Aguilella V, Royo P, Jiménez A, Bielsa M A, Arribas D
Department of Surgery, Hospital Clínico Universitario Lozano Blesa, 50009, Zaragoza, Spain.
Obes Surg. 2009 Apr;19(4):432-8. doi: 10.1007/s11695-008-9762-x. Epub 2008 Nov 12.
BACKGROUND: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.
背景：许多技术在2年的随访中取得了优异的效果，但关于其长期疗效的一些问题已经出现。这就是为什么必须在长期随访中分析减肥手术的结果。本研究的目的是将分析延长至5年，评估所实施手术的体重减轻、发病率和死亡率。 方法：这是一项对我们肥胖症外科实施的不同病态肥胖手术程序的回顾性队列研究。已根据体重减轻、发病率改善情况和术后发病率（减肥手术分析和报告结果系统）对结果进行了分析。 结果：125例患者接受了开放式垂直捆扎胃成形术（VBG），150例患者接受了斯科皮纳罗开放式胆胰转流术（BPD），100例患者接受了开放式改良BPD（共同肠袢75厘米；营养肠袢225厘米），115例患者接受了腹腔镜Roux-en-Y胃旁路术（LRYGBP）。平均随访时间为：VBG 12年，BPD 7年，LRYGBP 4年。在所有技术的随访第二年结束时均观察到了出色的初始体重减轻，但从那时起，VBG组出现了显著的体重反弹，LRYGBP组出现了轻微的体重反弹。到目前为止，只有BPD组保持了出色的体重结果。死亡率为：VBG 1.6%，BPD 1.2%，LRYGBP 0%。术后早期并发症为：VBG 25%，BPD 20.4%，LRYGBP 20%。术后晚期发病率为：斯科皮纳罗BPD组蛋白质营养不良11%，改良BPD组3%，VBG组和LRYGBP组均未报告病例；缺铁在VBG组为20%，斯科皮纳罗BPD组为62%，改良BPD组为40%，LRYGBP组为30.5%。由于体重完全反弹或呕吐，14.5%的VBG组患者需要接受改为胃旁路术或BPD的翻修手术。3.2%的斯科皮纳罗BPD伴有严重蛋白质营养不良的患者需要接受翻修手术，将共同肠袢延长至100厘米。0.8%的LRYGBP患者由于体重完全反弹需要接受改为远端LRYGBP（共同肠袢75厘米）的翻修手术。 结论：最复杂的减肥手术提高了有效性，但不幸的是也增加了发病率和死亡率。LRYGBP治疗病态肥胖安全有效。改良BPD（75 - 225厘米）可考虑用于治疗超级肥胖（体重指数>50 kg/m²），而诸如VBG等限制性手术由于长期随访失败率高，应仅在精心挑选的患者中进行。
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