Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Lancet Diabetes Endocrinol. 2017 Mar;5(3):165-173. doi: 10.1016/S2213-8587(16)30315-1. Epub 2017 Jan 6.
Little is known about the long-term outcomes of bariatric surgery for severe adolescent obesity, raising questions about the durability of early responses to surgery. We aimed to analyse long-term (>5 years) outcomes of Roux-en-Y gastric bypass in a cohort of young adults who had undergone the operation during adolescence, in the Follow-up of Adolescent Bariatric Surgery at 5 Plus Years (FABS-5+) extension study.
A cohort of young people aged 13-21 years underwent Roux-en-Y gastric bypass for clinically severe obesity at a paediatric academic medical centre in the USA. We did a prospective follow-up analysis of these patients' outcomes 5-12 years after surgery. Outcomes assessed included BMI, comorbidities, micronutrient status, safety, and other risks. The FABS study is registered with ClinicalTrials.gov, number NCT00776776.
Between May, 2001, and February, 2007, 74 young people underwent Roux-en-Y gastric bypass in the FABS study. Of these, 58 individuals were eligible for the FABS-5+ study, could be located, and agreed to follow-up assessment. At baseline, the mean age of the cohort was 17·1 years (SD 1·7) and mean BMI was 58·5 kg/m (10·5). At mean follow-up of 8·0 years (SD 1·6; range 5·4-12·5), the mean age of the cohort was 25·1 years (2·4) and mean BMI was 41·7 kg/m (12·0; mean change in BMI -29·2% [13·7]). From baseline to long-term follow-up, significant declines were recorded in the prevalence of elevated blood pressure (27/57 [47%] vs 9/55 [16%]; p=0·001), dyslipidaemia (48/56 [86%] vs 21/55 [38%]; p<0·0001), and type 2 diabetes (9/56 [16%] vs 1/55 [2%]; p=0·03). At follow-up, 25 (46%) of 58 patients had mild anaemia (ie, not requiring intervention), 22 (45%) had hyperparathyroidism, and eight (16%) had low amounts of vitamin B12 (ie, below the normal cutpoint).
Roux-en-Y gastric bypass surgery resulted in substantial and durable bodyweight reduction and cardiometabolic benefits for young adults. Long-term health maintenance after Roux-en-Y gastric bypass should focus on adherence to dietary supplements and screening and management of micronutrient deficiencies.
Ethicon Endosurgery, National Center for Advancing Translational Sciences (US National Institutes of Health).
对于严重青少年肥胖症的减重手术的长期结果知之甚少，这引发了对手术早期反应的持久性的疑问。我们旨在通过 FABS-5+ 研究中的青少年减重手术 5 年以上随访（Follow-up of Adolescent Bariatric Surgery at 5 Plus Years，FABS-5+）扩展研究，分析青少年时期接受 Roux-en-Y 胃旁路术的年轻成年人队列的长期（>5 年）结果。
一个由 13-21 岁青少年组成的队列在一家美国儿科学术医疗中心接受了临床严重肥胖的 Roux-en-Y 胃旁路术。我们对这些患者术后 5-12 年的结果进行了前瞻性随访分析。评估的结果包括 BMI、合并症、微量营养素状况、安全性和其他风险。FABS 研究在 ClinicalTrials.gov 上注册，编号为 NCT00776776。
2001 年 5 月至 2007 年 2 月，74 名年轻人在 FABS 研究中接受了 Roux-en-Y 胃旁路术。其中，58 名符合 FABS-5+研究条件、可定位并同意随访评估的患者被纳入研究。基线时，队列的平均年龄为 17.1 岁（标准差 1.7），平均 BMI 为 58.5kg/m²（10.5）。在平均 8.0 年（标准差 1.6；范围 5.4-12.5）的随访中，队列的平均年龄为 25.1 岁（2.4），平均 BMI 为 41.7kg/m²（12.0；BMI 平均变化 -29.2%[13.7]）。从基线到长期随访，高血压（27/57[47%] vs 9/55[16%]；p=0.001）、血脂异常（48/56[86%] vs 21/55[38%]；p<0.0001）和 2 型糖尿病（9/56[16%] vs 1/55[2%]；p=0.03）的患病率显著下降。在随访时，58 例患者中有 25 例（46%）出现轻度贫血（即无需干预），22 例（45%）出现甲状旁腺功能亢进，8 例（16%）出现维生素 B12 缺乏（即低于正常截断值）。
Roux-en-Y 胃旁路手术为年轻成年人带来了显著且持久的体重减轻和心脏代谢益处。Roux-en-Y 胃旁路术后的长期健康维护应侧重于坚持饮食补充剂，并筛查和管理微量营养素缺乏症。
Ethicon Endosurgery，国家转化医学推进中心（美国国立卫生研究院）。
