Abeles Deborah, Kim Julie J, Tarnoff Michael E, Shah Sajani, Shikora Scott A
Department of Surgery, Center for Minimally Invasive Obesity Surgery, Tufts Medical Center, Boston, MA, USA.
J Am Coll Surg. 2009 Feb;208(2):236-40. doi: 10.1016/j.jamcollsurg.2008.10.020. Epub 2008 Dec 18.
Several studies suggest patients with a body mass index (BMI; calculated as kg/m(2)) >or= 60 have a greater operative risk and so advocate a staged approach to bariatric procedures. This requires two separate operations and all associated risks. At our institution, we do not perform staged bariatric operations for these patients; we execute a single-stage laparoscopic Roux-en-Y gastric bypass (LGBP). Here, we analyze our experience in this population with a single-stage LGBP.
Ninety-five patients with a BMI >or= 60 were compared with 1,311 patients with BMI < 60 undergoing LGBP from December 2001 to May 2007. Data recorded included age, BMI, estimated blood loss, operating time, length of stay, and complications within the first 30 days after operation. Analyses of the data were performed using unpaired Student's t-test, with p < 0.05 as significant.
There were no statistically significant differences in age (42.6 versus 42.8 years), estimated blood loss (68.5 versus 69.5 mL), length of stay (3.1 versus 3.1 days), overall complications (12.7% versus 13.7%), or 30-day mortality (0.2% versus 0%) for patients with BMI < 60 as compared with patients with BMI >or= 60. The difference in operating time between the 2 groups was statistically significant (111 versus 118.7 minutes; p = 0.02) but likely reflected the learning curve.
In our experience, there were no differences in the incidence of complications or mortality for patients with a BMI >or= 60 undergoing LGBP as compared with those with a BMI < 60. These high-risk patients can safely undergo a single-stage LGBP.
多项研究表明，体重指数（BMI；计算方法为千克/平方米）≥60的患者手术风险更高，因此主张对减肥手术采用分期手术方式。这需要进行两次单独的手术以及承担所有相关风险。在我们机构，我们不对这些患者进行分期减肥手术；而是实施单阶段腹腔镜Roux-en-Y胃旁路术（LGBP）。在此，我们分析我们在这一人群中实施单阶段LGBP的经验。
将95例BMI≥60的患者与2001年12月至2007年5月期间接受LGBP的1311例BMI＜60的患者进行比较。记录的数据包括年龄、BMI、估计失血量、手术时间、住院时间以及术后30天内的并发症。使用非配对学生t检验对数据进行分析，p＜0.05为有统计学意义。
与BMI≥60的患者相比，BMI＜60的患者在年龄（42.6岁对42.8岁）、估计失血量（68.5毫升对69.5毫升）、住院时间（3.1天对3.1天）、总体并发症（12.7%对13.7%）或30天死亡率（0.2%对0%）方面无统计学显著差异。两组之间的手术时间差异有统计学意义（111分钟对118.7分钟；p = 0.02），但这可能反映了学习曲线。
根据我们的经验，与BMI＜60的患者相比，BMI≥60的患者接受LGBP时并发症发生率或死亡率并无差异。这些高危患者可以安全地接受单阶段LGBP。
