Internal Medicine, Department of Medical Pathophysiology, I Faculty of Medicine, Sapienza University, Rome, Italy.
Int J Obes (Lond). 2010 Sep;34(9):1404-14. doi: 10.1038/ijo.2010.54. Epub 2010 Apr 20.
Obesity is an increasing health problem and surgery seems to be the only treatment effective in achieving weight loss without relapse. Among bariatric techniques, many differences exist in terms of weight loss and resolution of comorbidities. Up to now, there are no prospective studies comparing long-term effects of malabsorptive vs restrictive techniques.
In this study, cardiometabolic risk factors and body composition changes after malabsorptive biliointestinal bypass (BIBP) and restrictive laparoscopic adjustable gastric banding (LAGB) were compared during a 4-year follow-up.
Prospective, case-control and cohort study.
In all, 80 obese subjects, matched for weight and age. Altogether, 40 patients underwent BIBP and 40 underwent LAGB.
Weight, body composition, fasting and post-loading plasma glucose and insulin, homeostatic model assessment index (HOMA-I), lipid profile, blood pressure (BP), erythrocyte sedimentation rate and fibrinogen were monitored at baseline, 12 and 48 months.
At 12 months after surgery, a significant reduction in body mass index, total fat mass (FM), trunk FM (trFM), trFM/legs FM (lFM) ratio (trFM/lFM), triglycerides, BP and inflammation markers was observed in both groups. BIBP patients showed a significant reduction in total cholesterol (Tot-C), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), whereas the LAGB group showed a significant increase of HDL-C. A further improvement of all the parameters evaluated was seen in the BIBP group at 48 months after surgery.
Both bariatric procedures exerted positive effects on cardiometabolic risk factors and on weight loss in the population studied, but on the long-term period, HOMA-I, Tot-C/HDL-C ratio and body composition improvements were more evident after BIBP. We conclude that malabsorptive BIBP seems to be more effective than LAGB in treating visceral obesity and its metabolic complications.
肥胖是一个日益严重的健康问题，手术似乎是唯一有效的治疗方法，可以在不复发的情况下减轻体重。在减重手术技术中，在减轻体重和解决合并症方面存在许多差异。到目前为止，还没有前瞻性研究比较吸收不良与限制技术的长期效果。
在这项研究中，比较了吸收不良性胆肠旁路术（BIBP）和限制性腹腔镜可调胃束带术（LAGB）术后 4 年期间对心血管代谢风险因素和身体成分的影响。
前瞻性、病例对照和队列研究。
共 80 名肥胖患者，体重和年龄匹配。共有 40 例患者接受 BIBP 治疗，40 例患者接受 LAGB 治疗。
体重、身体成分、空腹和负荷后血浆葡萄糖和胰岛素、稳态模型评估指数（HOMA-I）、血脂谱、血压（BP）、红细胞沉降率和纤维蛋白原，分别在基线、12 个月和 48 个月进行监测。
手术后 12 个月，两组患者的体重指数、总脂肪量（FM）、躯干 FM（trFM）、trFM/下肢 FM（lFM）比值（trFM/lFM）、甘油三酯、BP 和炎症标志物均显著降低。BIBP 组患者总胆固醇（Tot-C）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）显著降低，而 LAGB 组患者 HDL-C 显著升高。手术后 48 个月，BIBP 组所有参数均进一步改善。
两种减重手术均对所研究人群的心血管代谢风险因素和体重减轻产生积极影响，但在长期内，BIBP 术后 HOMA-I、Tot-C/HDL-C 比值和身体成分改善更为明显。我们的结论是，吸收不良性 BIBP 似乎比 LAGB 更能有效治疗内脏肥胖及其代谢并发症。
