Obesity Unit, Department of Diabetes and Endocrinology, IDIBAPS, ICMDM, Hospital Clínic i Universitari, C/Villarroel 170, 08036 Barcelona, Spain.
Surg Endosc. 2012 Jun;26(6):1744-50. doi: 10.1007/s00464-011-2104-4. Epub 2012 Jan 11.
Bariatric surgery (BS) is widely accepted for the treatment of patients with morbid obesity (MO). We aimed to determine presurgical predictors of and surgical technique-related differences in excess weight loss (EWL) 1 year after BS.
This retrospective study included 407 subjects (F/M 3:1, median age = 44 years) who underwent laparoscopic Roux-en-Y gastric bypass (RYGB, n = 307) or sleeve gastrectomy (SG, n = 100) at our University Hospital and were evaluated 1 year after surgery.
Baseline median (min-max) body mass index (BMI) was 47 kg/m(2) (range = 36-71). BMI was higher in the SG than in the RYGB group (53 vs. 46 kg/m(2), p < 0.0001). Simple correlation analysis showed negative associations between EWL and age, BMI, waist circumference (WC), fasting glucose, HbA1c, triglycerides (TG), blood pressure, and total cholesterol (all p < 0.01). EWL (mean ± SD) did not differ by gender (p = 0.2), was lower in diabetic than in nondiabetic subjects (71 ± 17% vs. 79 ± 17%, p < 0.0001), and higher in the RYGB vs. SG group (76 ± 18% vs. 68 ± 15%, p < 0.0001). However, SG vs. RYGB differences in EWL disappeared (p = 0.4) after taking into account baseline BMI. Multiple regression and logistic analysis showed that younger individuals with lower BMI but higher WC, and lower HbA1c and TG, had higher EWL and a higher rate of successful (EWL ≥ 60%) weight loss.
Our data indicate that some of the characteristics that would have subjects referred early for BS were associated with higher weight loss. Therefore, the timing of laparoscopic BS might be an important factor for MO individuals in which medical weight loss intervention has failed.
减重手术（BS）被广泛用于治疗病态肥胖（MO）患者。我们旨在确定 BS 后 1 年超重减轻（EWL）的术前预测因子和与手术技术相关的差异。
这项回顾性研究纳入了 407 名（男女比例 3:1，中位年龄为 44 岁）在我们大学医院接受腹腔镜 Roux-en-Y 胃旁路术（RYGB，n=307）或袖状胃切除术（SG，n=100）的患者，并在术后 1 年进行评估。
基线时（中位数[最小-最大]）体重指数（BMI）为 47kg/m²（范围=36-71）。SG 组的 BMI 高于 RYGB 组（53 与 46kg/m²，p<0.0001）。简单相关分析显示 EWL 与年龄、BMI、腰围（WC）、空腹血糖、HbA1c、甘油三酯（TG）、血压和总胆固醇呈负相关（均 p<0.01）。性别之间 EWL 无差异（p=0.2），糖尿病患者的 EWL 低于非糖尿病患者（71±17%与 79±17%，p<0.0001），RYGB 组的 EWL 高于 SG 组（76±18%与 68±15%，p<0.0001）。然而，考虑到基线 BMI 后，SG 与 RYGB 之间 EWL 的差异消失（p=0.4）。多元回归和逻辑分析显示，BMI 较低但 WC 较高、HbA1c 和 TG 较低的年轻个体具有更高的 EWL 和更高的成功减重率（EWL≥60%）。
我们的数据表明，一些导致患者早期接受 BS 的特征与更高的减重效果相关。因此，腹腔镜 BS 的时机可能是接受过医学减重干预但仍失败的 MO 个体的一个重要因素。
