Clough Anthony, Hamill Daniel, Jackson Shane, Remilton Michael, Eyre Rosemarie, Callahan Rosie
Eastern Health Network, Melbourne, Victoria, Australia.
ANZ J Surg. 2017 Nov;87(11):930-934. doi: 10.1111/ans.13585. Epub 2016 Apr 12.
In Australia, over 90% of bariatric surgery is performed in the private sector by paying patients with health insurance. The demand for government funded services is overwhelming and data are needed on the efficiency, safety and effectiveness of the current range of bariatric procedures in a public hospital setting. The aim of this study was to document medium term outcomes of gastric banding (laparoscopic adjustable gastric banding (LAGB)), gastric bypass (Roux-en-Y gastric bypass (RYGB)) and sleeve gastrectomy (SG) in a publicly funded programme.
Primary cases with minimum 18 months' follow up were included. Hospital usage, complications, weight loss and co-morbidity outcomes were compared.
A total of 229 patients (125 LAGB, 42 RYGB, 62 SG) were included. Mean weight (body mass index) for LAGB, RYGB and SG was 130.6 (46.3), 137.2 (50.5) and 162.7 (55.2) kg (kg/m ), respectively (P < 0.001). Operative time and hospital stay were longest for RYGB and intensive care stay was longest for SG. Major complications occurred at 0.0%, 11.9% and 12.9% (P < 0.001) and major reoperations occurred over 5 years 11.2%, 21.4% and 6.5% (P = 0.064). Mean (standard deviation) excess weight loss was 29.9% (33.1), 75.7% (31.8) and 52.7% (19.7) with mean follow up of 3.6 years and 79.0% complete data.
In our public bariatric programme, LAGB patients perform relatively poorly. An increased focus on SG may be appropriate as weight loss is more reliable, major reoperation rates are low and follow up less important. Our experience should be useful for those considering how best to structure and fund a public bariatric programme.
在澳大利亚，超过90%的减肥手术是由有医疗保险的付费患者在私立机构进行的。政府资助服务的需求极为庞大，因此需要了解公立医院环境下当前一系列减肥手术的效率、安全性和有效性数据。本研究的目的是记录一项政府资助项目中胃束带术（腹腔镜可调节胃束带术（LAGB））、胃旁路术（Roux-en-Y胃旁路术（RYGB））和袖状胃切除术（SG）的中期结果。
纳入至少随访18个月的初治病例。比较医院使用情况、并发症、体重减轻和合并症结果。
共纳入229例患者（125例LAGB、42例RYGB、62例SG）。LAGB、RYGB和SG的平均体重（体重指数）分别为130.6（46.3）、137.2（50.5）和162.7（55.2）kg（kg/m²）（P<0.001）。RYGB的手术时间和住院时间最长，SG的重症监护时间最长。主要并发症发生率分别为0.0%、11.9%和12.9%（P<0.001），5年内主要再次手术发生率分别为11.2%、21.4%和6.5%（P=0.064）。平均（标准差）超重减轻率分别为29.9%（33.1）、75.7%（31.8）和52.7%（19.7），平均随访3.6年，完整数据率为79.0%。
在我们的公共减肥项目中，LAGB患者的表现相对较差。由于SG减肥效果更可靠、主要再次手术率低且随访不太重要，因此可能应更多地关注SG。我们的经验对那些考虑如何以最佳方式构建和资助公共减肥项目的人应有所帮助。
