Okafor Philip N, Lien Chueh, Bairdain Sigrid, Simonson Donald C, Halperin Florencia, Vernon Ashley H, Linden Bradley C, Lautz David B
Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, United States.
Department of Surgery, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States.
Obes Res Clin Pract. 2015 May-Jun;9(3):274-80. doi: 10.1016/j.orcp.2014.09.005. Epub 2014 Oct 18.
During Roux-en-Y gastric bypasses (RYGB), some surgeons elect to perform a vagotomy to reduce symptoms of gastro-oesophageal reflux (GER). Routine vagotomy during RYGB may independently affect weight loss and metabolic outcomes following bariatric surgery. We aimed to determine whether vagotomy augments percent excess weight loss in obese patients after RYGB.
We examined the effect of vagotomy in 1278 patients undergoing RYGB at our institution from 2003 to 2009. Weight and percent excess weight loss (%EWL) were modelled at three months and annually up to five years using a longitudinal linear mixed model controlling for differences in age, gender, initial body mass index (BMI), ideal body weight, and presence of vagotomy.
Vagotomy was performed on 40.3% of our cohort. Vagotomy patients had significantly lower initial BMI (46.4±6.2 vs. 48.3±7.7kg/m(2), p<0.001), but there were no other significant differences at baseline. The strongest predictor of %EWL over time was initial BMI, with lower BMI patients exhibiting greater %EWL (p<0.001). Age and gender effects were also significant, with younger patients (p<0.04) and males (p<0.002) attaining greater %EWL. Vagotomy had no effect on %EWL in either simple or multiple regression models.
Our series suggest that vagotomy does not augment %EWL when performed with RYGB.
在Roux-en-Y胃旁路手术（RYGB）过程中，一些外科医生选择进行迷走神经切断术以减轻胃食管反流（GER）症状。RYGB手术中常规的迷走神经切断术可能会独立影响减肥手术后的体重减轻和代谢结果。我们旨在确定迷走神经切断术是否能增加肥胖患者RYGB术后的超重减轻百分比。
我们研究了2003年至2009年在我院接受RYGB手术的1278例患者中迷走神经切断术的效果。使用纵向线性混合模型，在3个月时以及每年直至5年时对体重和超重减轻百分比（%EWL）进行建模，该模型控制了年龄、性别、初始体重指数（BMI）、理想体重和迷走神经切断术的存在等方面的差异。
我们队列中有40.3%的患者进行了迷走神经切断术。接受迷走神经切断术的患者初始BMI显著更低（46.4±6.2 vs. 48.3±7.7kg/m²，p<0.001），但在基线时没有其他显著差异。随着时间推移，%EWL的最强预测因素是初始BMI，BMI较低的患者表现出更高的%EWL（p<0.001）。年龄和性别效应也很显著，年轻患者（p<0.04）和男性（p<0.002）的%EWL更高。在简单或多元回归模型中，迷走神经切断术对%EWL均无影响。
我们的系列研究表明，RYGB手术时进行迷走神经切断术并不会增加%EWL。
