Departments of Gastrointestinal Surgery, Oslo University Hospital Aker, Oslo, Norway.
Br J Surg. 2010 Feb;97(2):160-6. doi: 10.1002/bjs.6802.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic biliopancreatic diversion with duodenal switch (LDS) are surgical options for superobesity. A randomized trial was conducted to evaluate perioperative (30-day) safety and 1-year results.
Sixty patients with a body mass index (BMI) of 50-60 kg/m(2) were randomized to LRYGB or LDS. BMI, percentage of excess BMI lost, complications and readmissions were compared between groups.
Patient characteristics were similar in the two groups. Mean operating time was 91 min for LRYGB and 206 min for LDS (P < 0.001). One LDS was converted to open surgery. Early complications occurred in four patients undergoing LRYGB and seven having LDS (P = 0.327), with no deaths. Median stay was 2 days after LRYGB and 4 days after LDS (P < 0.001). Four and nine patients respectively had late complications (P = 0.121). Mean BMI at 1 year decreased from 54.8 to 38.5 kg/m(2) after LRYGB and from 55.2 to 32.5 kg/m(2) after LDS; percentage of excess BMI lost was greater after LDS (74.8 versus 54.4 per cent; P < 0.001).
LRYGB and LDS can be performed with comparable perioperative safety in superobese patients. LDS provides greater weight loss in the first year.
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）和腹腔镜胆胰分流加十二指肠转位术（LDS）是治疗超级肥胖的手术选择。一项随机试验评估了围手术期（30 天）安全性和 1 年结果。
将 60 名 BMI 为 50-60kg/m²的患者随机分为 LRYGB 或 LDS 组。比较两组间 BMI、多余体重减轻百分比、并发症和再入院率。
两组患者的特征相似。LRYGB 的平均手术时间为 91 分钟，LDS 为 206 分钟（P<0.001）。1 例 LDS 转为开放手术。LRYGB 术后有 4 例发生早期并发症，LDS 术后有 7 例（P=0.327），无死亡病例。LRYGB 术后中位住院时间为 2 天，LDS 术后为 4 天（P<0.001）。LRYGB 术后分别有 4 例和 LDS 术后有 9 例发生晚期并发症（P=0.121）。LRYGB 术后 1 年 BMI 从 54.8kg/m²降至 38.5kg/m²，LDS 术后从 55.2kg/m²降至 32.5kg/m²；LDS 术后多余体重减轻百分比更大（74.8%比 54.4%；P<0.001）。
LRYGB 和 LDS 可用于超级肥胖患者，围手术期安全性相当。LDS 在术后 1 年内可提供更大的减重效果。
