Park Ji Yeon, Kim Yong Jin
Ji Yeon Park, Yong Jin Kim, Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul 140-743, South Korea.
World J Gastroenterol. 2015 Nov 28;21(44):12612-9. doi: 10.3748/wjg.v21.i44.12612.
To compare the mid-term outcomes of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in obese Korean patients.
All consecutive patients who underwent either LSG or LRYGB with primary to treat morbid obesity between January 2011 and December 2012 were retrospectively reviewed. Patients with a body mass index (BMI) ≥ 30 kg/m(2) with inadequately controlled obesity-related comorbidities (e.g., diabetes, obstructive sleep apnea, hypertension, or obesity-related arthropathy) or BMI ≥ 35 kg/m(2) were considered for bariatric surgery according to the International Federation for the Surgery of Obesity-Asia Pacific Chapter Consensus statements in 2011. The decision regarding the procedure type was made on an individual basis following extensive discussion with the patient about the specific risks associated with each procedure. All operative procedures were performed laparoscopically by a single surgeon experienced in upper gastrointestinal surgeries. Baseline demographics, perioperative surgical outcomes, and postoperative anthropometric data from a prospectively established database were thoroughly reviewed and compared between the two surgical approaches.
One hundred four patients underwent LSG, and 236 underwent LRYGB. Preoperative BMI in the LSG group was significantly higher than that of the LRYGB group (38.6 kg/m(2) vs 37.2 kg/m(2), P = 0.024). Patients with diabetes were more prevalent in the LRYGB group (18.3% vs 35.6%, P = 0.001). Operating time and hospital stay were significantly shorter in the LSG group compared with the LRYGB group (100 min vs 130 min, P < 0.001; 1 d vs 2 d, P = 0.003), but the incidence of perioperative complications was similar between the groups (P = 0.351). The mean percentage of excess weight loss (%EWL) was 71.2% for LRYGB, while it was 63.5% for LSG, at mean follow-up periods of 18.0 and 21.0 mo, respectively (P = 0.073). The %EWL at 1, 3, 6, 12, 18, 24, and 36 mo was equivalent between the groups. Four patients required surgical revision after LSG (4.8%), while revision was only required in one case following LRYGB (0.4%; P = 0.011).
Both LSG and LRYGB are effective procedures that induce comparable weight loss in the mid-term and similar surgical risks, except for the higher revision rate after LSG.
比较腹腔镜袖状胃切除术（LSG）和腹腔镜Roux-en-Y胃旁路术（LRYGB）在肥胖韩国患者中的中期疗效。
回顾性分析2011年1月至2012年12月期间连续接受LSG或LRYGB治疗病态肥胖的所有患者。根据2011年亚太地区肥胖外科学会联合会共识声明，体重指数（BMI）≥30kg/m²且肥胖相关合并症（如糖尿病、阻塞性睡眠呼吸暂停、高血压或肥胖相关关节病）控制不佳的患者或BMI≥35kg/m²的患者被考虑进行减肥手术。在与患者广泛讨论每种手术的具体风险后，根据个体情况决定手术类型。所有手术均由一位在上消化道手术方面经验丰富的外科医生通过腹腔镜进行。对前瞻性建立的数据库中的基线人口统计学、围手术期手术结果和术后人体测量数据进行了全面回顾，并在两种手术方法之间进行了比较。
104例患者接受了LSG，236例患者接受了LRYGB。LSG组术前BMI显著高于LRYGB组（38.6kg/m²对37.2kg/m²，P = 0.024）。LRYGB组糖尿病患者更为普遍（18.3%对35.6%，P = 0.001）。与LRYGB组相比，LSG组的手术时间和住院时间显著缩短（100分钟对130分钟，P < 0.001；1天对2天，P = 0.003），但两组围手术期并发症发生率相似（P = 0.351）。在平均随访期分别为18.0个月和21.0个月时，LRYGB组的平均超重减轻百分比（%EWL）为71.2%，而LSG组为63.5%（P = 0.073）。两组在1、3、6、12、18、24和36个月时的%EWL相当。4例患者在LSG后需要手术翻修（4.8%），而LRYGB后仅1例需要翻修（0.4%；P = 0.011）。
LSG和LRYGB都是有效的手术方法，在中期能导致相当的体重减轻，且手术风险相似，只是LSG后的翻修率较高。
