Dogan Kemal, Gadiot Ralph P M, Aarts Edo O, Betzel Bark, van Laarhoven Cees J H M, Biter Laser U, Mannaerts Guido H H, Aufenacker Theo J, Janssen Ignace M C, Berends Frits J
Department of Surgery, Rijnstate Hospital, Postal number 1190, PO box 9555, 6800 TA, Arnhem, The Netherlands,
Obes Surg. 2015 Jul;25(7):1110-8. doi: 10.1007/s11695-014-1503-8.
Laparoscopic adjustable gastric band (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y gastric bypass (LRYGB) are the most performed procedures worldwide (92 %) nowadays. However, comparative clinical trials are scarce in literature. The objective of this study was to compare the effectiveness and safety of the three most performed bariatric procedures.
A multicenter, retrospective, matched cohort study was conducted. Patients were eligible for analysis when a primary procedure was performed between 2007 and 2010 in one of the two specialized bariatric centers. Primary outcome was weight loss, expressed in the percentage excess weight loss (%EWL). Secondary outcome parameters are hospital stay, complication rate, and revisional surgery.
In total, 735 patients, 245 in each group, were included for analysis. The groups were comparable for age and gender after matching. Mean postoperative follow-up was 3.1 ± 1.2 years. LAGB patients showed less %EWL compared to LSG and LRYGB at all postoperative follow-up visits. LRYGB showed a %EWL of 71 ± 20 % compared to LSG (76 ± 23 %; p=0.008) after 1-year follow-up; thereafter, no significant difference was observed. After 3 years of follow-up, LAGB showed a higher complication rate compared to LSG and LRYGB (p<0.05). Revisional surgery after LAGB was needed in 21 %, while 9 % of the LSG underwent conversion to RYGB.
LRYGB is a safe and effective treatment in morbid obese patients with good long-term outcomes. LSG seems to be an appropriate alternative as a definitive procedure, in terms of weight reduction and complication rate. LAGB is inferior to both LRYGB and LSG.
腹腔镜可调节胃束带术（LAGB）、腹腔镜袖状胃切除术（LSG）和腹腔镜Roux-en-Y胃旁路术（LRYGB）是目前全球施行最多的手术（占92%）。然而，文献中比较性临床试验较少。本研究的目的是比较这三种施行最多的减肥手术的有效性和安全性。
进行了一项多中心、回顾性、匹配队列研究。当2007年至2010年在两个专门的减肥中心之一进行初次手术时，患者符合分析条件。主要结局是体重减轻，以超重减轻百分比（%EWL）表示。次要结局参数包括住院时间、并发症发生率和翻修手术。
总共纳入735例患者，每组245例进行分析。匹配后各组在年龄和性别方面具有可比性。术后平均随访3.1±1.2年。在所有术后随访中，LAGB患者的%EWL低于LSG和LRYGB患者。随访1年后，LRYGB的%EWL为71±20%，而LSG为76±23%（p=0.008）；此后，未观察到显著差异。随访3年后，LAGB的并发症发生率高于LSG和LRYGB（p<0.05）。21%的LAGB患者需要进行翻修手术，而9%的LSG患者转为RYGB。
LRYGB是治疗病态肥胖患者的一种安全有效的方法，长期效果良好。就体重减轻和并发症发生率而言，LSG似乎是一种合适的确定性手术替代方案。LAGB不如LRYGB和LSG。
