Kothari Shanu N, Borgert Andrew J, Kallies Kara J, Baker Matthew T, Grover Brandon T
Department of General Surgery, Gundersen Health System, La Crosse, Wisconsin.
Department of Research, Gundersen Medical Foundation, La Crosse, Wisconsin.
Surg Obes Relat Dis. 2017 Jun;13(6):972-978. doi: 10.1016/j.soard.2016.12.011. Epub 2016 Dec 22.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) has been the "gold standard" for weight loss surgery. Long-term data are limited, and reporting methods for LRYGB outcomes vary in the literature. In addition, follow-up compliance within bariatric centers is poor due to insurance and access to care issues, making long-term follow-up evaluation difficult.
Evaluate long-term LRYGB outcomes using standard outcome reporting definitions.
Integrated multispecialty health system.
A retrospective review of our institution's prospective bariatric surgery registry and integrated multispecialty electronic medical record system was completed for patients who underwent LRYGB from 2001 to 2015. Data were defined according to the 2015 Standards for Outcome Reporting.
During the study period, 1402 patients underwent primary LRYGB; mean age and preoperative body mass index were 44.5±10.3 years and 47.5±6.2 kg/m, respectively. Early complications included anastomotic leak (0.2%), venous thromboembolism (0.6%), surgical site infections (1.4%), and urinary tract infections (1.6%). The 30-day readmission rate was 3.5%. There were no 30-day mortalities. Follow-up weight data were available for>70% of eligible patients through 12 years postoperative. The highest mean percent excess weight loss and lowest body mass index were reached at 18 months postoperative at 79% and 30.1 kg/m, respectively. Remission of diabetes, dyslipidemia, and hypertension were observed through 8 years postoperatively.
This is the first report of long-term (>10-year) outcomes from a single integrated health system using the 2015 Standards for Outcome Reporting. LRYGB results in significant, sustained weight loss and durable improvement and remission of obesity-related co-morbidities. Integrated healthcare systems provide an optimal environment for data collection and long-term follow-up.
腹腔镜Roux-en-Y胃旁路术（LRYGB）一直是减肥手术的“金标准”。长期数据有限，且LRYGB手术结果的报告方法在文献中各不相同。此外，由于保险和医疗服务获取问题，减肥中心的随访依从性较差，使得长期随访评估变得困难。
使用标准结果报告定义评估LRYGB的长期手术结果。
综合多专科医疗系统。
对2001年至2015年接受LRYGB手术的患者，回顾性查阅了本机构前瞻性减肥手术登记册和综合多专科电子病历系统。数据根据2015年结果报告标准进行定义。
在研究期间，1402例患者接受了初次LRYGB手术；平均年龄和术前体重指数分别为44.5±10.3岁和47.5±6.2kg/m²。早期并发症包括吻合口漏（0.2%）、静脉血栓栓塞（0.6%）、手术部位感染（1.4%）和尿路感染（1.6%）。30天再入院率为3.5%。无30天死亡率。术后12年，超过70%的符合条件患者有随访体重数据。术后18个月时，平均超重减轻百分比最高，体重指数最低，分别为79%和30.1kg/m²。术后8年观察到糖尿病、血脂异常和高血压缓解。
这是首个来自单一综合医疗系统、使用2015年结果报告标准的长期（>10年）手术结果报告。LRYGB可实现显著、持续的体重减轻，并能持久改善和缓解肥胖相关合并症。综合医疗系统为数据收集和长期随访提供了最佳环境。
