Kowalewski Piotr K, Olszewski Robert, Walędziak Maciej S, Janik Michał R, Kwiatkowski Andrzej, Gałązka-Świderek Natalia, Cichoń Krzysztof, Brągoszewski Jakub, Paśnik Krzysztof
Department of General Surgery, Military Institute of Medicine, Szaserów 128, 04-141, Warsaw, Poland.
Department of Geriatrics, National Institute of Geriatrics Rheumatology and Rehabilitation, Warsaw, Poland.
Obes Surg. 2018 Jan;28(1):130-134. doi: 10.1007/s11695-017-2795-2.
Sleeve gastrectomy (LSG) is one of the most popular bariatric procedures. We present our long-term results regarding weight loss, comorbidities, and gastric reflux disease.
We identified patients who underwent LSG in our institution between 2006 and 2009. We revised the data, and the patients with outdated contact details were tracked with the national health insurance database and social media (facebook). Each of the identified patients was asked to complete an online or telephone survey covering, among others, their weight and comorbidities. On that basis, we calculated the percent total weight loss (%TWL) and percent excess weight loss (%EWL), along with changes in body mass index (ΔBMI). Satisfactory weight loss was set at >50% EWL (for BMI = 25 kg/m). We evaluated type 2 diabetes (T2DM) and arterial hypertension (AHT) based on the pharmacological therapy. GERD presence was evaluated by the typical symptoms and/or proton pump inhibitor (PPI) therapy.
One hundred twenty-seven patients underwent LSG between 2006 and 2009. One hundred twenty patients were qualified for this study. Follow-up data was available for 100 participants (47 female, 53 male). Median follow-up period reached 8.0 years (from 7.1 to 10.7). Median BMI upon qualification for LSG was 51.6 kg/m. Sixteen percent of patients required revisional surgery over the years (RS group), mainly because of insufficient weight loss (14 Roux-Y gastric bypass-LRYGB; one mini gastric bypass, one gastric banding). For the LSG (LSG group n = 84), the mean %EWL was 51.1% (±22.3), median %TWL was 23.5% (IQR 17.7-33.3%), and median ΔBMI was 12.1 kg/m (IQR 8.2-17.2). Fifty percent (n = 42) of patients achieved the satisfactory %EWL of 50%. For RS group, the mean %EWL was 57.8% (±18.2%) and median %TWL reached 33% (IQR 27.7-37.9%). Sixty-two percent (n = 10) achieved the satisfactory weight loss. Fifty-nine percent of patients reported improvement in AHT therapy, 58% in T2DM. After LSG, 60% (n = 60) of patients reported recurring GERD symptoms and 44% were treated with proton pomp inhibitors (PPI). In 93% of these cases, GERD has developed de novo.
Isolated LSG provides fairly good effects in a long-term follow-up with mean %EWL at 51.1%. Sixteen percent of patients require additional surgery due to insufficient weight loss. More than half of the subjects observe improvement in AHT and T2DM. Over half of the patients complain of GERD symptoms, which in most of the cases is a de novo complaint.
袖状胃切除术（LSG）是最受欢迎的减肥手术之一。我们展示了关于体重减轻、合并症和胃反流疾病的长期结果。
我们确定了2006年至2009年间在我们机构接受LSG的患者。我们修订了数据，通过国家医疗保险数据库和社交媒体（脸书）追踪了联系方式过时的患者。要求每位确定的患者完成一项在线或电话调查，内容包括他们的体重和合并症等。在此基础上，我们计算了总体重减轻百分比（%TWL）和超重减轻百分比（%EWL），以及体重指数的变化（ΔBMI）。设定满意的体重减轻为>50%EWL（对于BMI = 25 kg/m）。我们根据药物治疗评估2型糖尿病（T2DM）和动脉高血压（AHT）。通过典型症状和/或质子泵抑制剂（PPI）治疗评估胃食管反流病（GERD）的存在情况。
2006年至2009年间有127例患者接受了LSG。120例患者符合本研究条件。100名参与者（47名女性，53名男性）有随访数据。中位随访期达8.0年（7.1至10.7年）。接受LSG时的中位BMI为51.6 kg/m。多年来16%的患者需要进行翻修手术（RS组），主要原因是体重减轻不足（14例行Roux - Y胃旁路术 - LRYGB；1例行迷你胃旁路术，1例行胃束带术）。对于LSG组（n = 84），平均%EWL为51.1%（±22.3），中位%TWL为23.5%（四分位间距17.7 - 33.3%），中位ΔBMI为12.1 kg/m（四分位间距8.2 - 17.2）。50%（n = 42）的患者达到了50%的满意%EWL。对于RS组，平均%EWL为57.8%（±18.2%），中位%TWL达到33%（四分位间距27.7 - 37.9%）。62%（n = 10）的患者实现了满意的体重减轻。59%的患者报告AHT治疗有改善，58%的患者T2DM有改善。LSG后，60%（n = 60）的患者报告有复发性GERD症状，44%接受了质子泵抑制剂（PPI）治疗。在这些病例中，93%的GERD是新发的。
单纯LSG在长期随访中效果相当不错，平均%EWL为51.1%。16%的患者因体重减轻不足需要额外手术。超过一半的受试者观察到AHT和T2DM有改善。超过一半的患者抱怨有GERD症状，在大多数情况下这是新发的症状。
