Fuchs Hans F, Laughter Vanessa, Harnsberger Cristina R, Broderick Ryan C, Berducci Martin, DuCoin Christopher, Langert Joshua, Sandler Bryan J, Jacobsen Garth R, Perry William, Horgan Santiago
Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.
Department of Surgery, University of Cologne, Cologne, Germany.
Surg Endosc. 2016 Jan;30(1):251-8. doi: 10.1007/s00464-015-4196-8. Epub 2015 Apr 7.
Patients with psychiatric disorder were reported to have a poor outcome in bariatric surgery. Few studies have examined the outcome of laparoscopic sleeve gastrectomy (LSG) and laparoscopic adjustable gastric banding (LAGB) in patients with psychiatric history. We aimed to compare excess weight loss (%EWL) in patients with and without psychiatric comorbidities who underwent LSG or LAGB.
Patients undergoing LSG or LAGB were identified from our prospective database. A multidisciplinary team evaluated all patients preoperatively, including a psychological evaluation. Patients with the diagnosis of depression, anxiety, bipolar disorder, and schizophrenia were included in the psychiatric comorbidity group (PSY). Others were included in group NON-PSY. All patients were first screened to be psychologically stable to undergo surgery. Initial BMI and %EWL at 3, 6, and 12 months postoperatively were compared.
A total of 590 patients (81.4 % women), with a median BMI of 43.8 kg/m(2) (range 30-99) who underwent LSG (n = 222) or LAGB (n = 368) from January 2006 to June 2013, were identified. Psychiatric comorbidities that were well controlled at the time of surgery were found in 188 patients (31.9%). Diagnostic criteria for depression were met in 154 patients (26.1%), 75 patients suffered from anxiety (12.7%), 9 from bipolar disorder, and 4 from schizophrenia (0.7%). Initial BMI was not different between the two groups. No significant difference in %EWL between the groups was found during follow-up (44.13 vs. 43.37%EWL, respectively, at 1 year; p = 0.76). When LSG and LAGB patients were analyzed as subsets, again no difference in %EWL at 1 year was found for PSY vs. NON-PSY (LSG: 51.56 vs. 54.86%EWL; LAGB: 38.48 vs. 38.45%EWL, all p = ns). In multivariate analysis, the differences from unadjusted analysis persisted.
These findings demonstrate that a similar %EWL can be achieved in patients undergoing LSG or LAGB despite the presence of well-controlled psychiatric comorbidity.
据报道，患有精神疾病的患者在减肥手术中的预后较差。很少有研究探讨有精神病史的患者接受腹腔镜袖状胃切除术（LSG）和腹腔镜可调节胃束带术（LAGB）的预后情况。我们旨在比较接受LSG或LAGB的有和没有精神疾病合并症患者的超重减轻百分比（%EWL）。
从我们的前瞻性数据库中识别出接受LSG或LAGB的患者。一个多学科团队在术前对所有患者进行评估，包括心理评估。诊断为抑郁症、焦虑症、双相情感障碍和精神分裂症的患者被纳入精神疾病合并症组（PSY）。其他患者被纳入非PSY组。所有患者首先经过筛查，确保心理稳定才能接受手术。比较患者术前的初始体重指数（BMI）以及术后3个月、6个月和12个月时的%EWL。
共识别出590例患者（81.4%为女性），他们在2006年1月至2013年6月期间接受了LSG（n = 222）或LAGB（n = 368）手术，中位BMI为43.8 kg/m²（范围30 - 99）。在188例患者（31.9%）中发现手术时精神疾病合并症得到良好控制。154例患者（26.1%）符合抑郁症诊断标准，75例患者患有焦虑症（12.7%），9例患有双相情感障碍，4例患有精神分裂症（0.7%）。两组患者的初始BMI无差异。随访期间两组患者的%EWL无显著差异（1年时分别为44.13%EWL和43.37%EWL；p = 0.76）。当将LSG和LAGB患者作为亚组进行分析时，PSY组与非PSY组在1年时的%EWL同样没有差异（LSG组：51.56%EWL对54.86%EWL；LAGB组：38.48%EWL对38.45%EWL，所有p值均无统计学意义）。在多变量分析中，与未调整分析的差异依然存在。
这些研究结果表明，尽管存在得到良好控制的精神疾病合并症，但接受LSG或LAGB手术的患者仍可实现相似的%EWL。
