Nassour Ibrahim, Almandoz Jaime P, Adams-Huet Beverley, Kukreja Sachin, Puzziferri Nancy
Department of Surgery.
Department of Internal Medicine, Division of Endocrinology.
Diabetes Metab Syndr Obes. 2017 Sep 20;10:393-402. doi: 10.2147/DMSO.S142731. eCollection 2017.
Bariatric surgery is known to decrease weight and the prevalence of comorbidities, but there is little evidence on the differential effect of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on the remission of the aggregate outcome, metabolic syndrome, 4 years after surgery. The purpose of this study was to determine the effectiveness of RYGB and SG on metabolic syndrome in veterans.
We retrospectively reviewed consecutive patients who underwent SG and RYGB at the Dallas Veterans Affairs Medical Center from 2003 to 2012. We determined the effect of both the operations on the remission of metabolic syndrome, its individual components, and medium-term morbidity and mortality. A sensitivity analysis was performed using propensity matching.
A total of 266 patients were identified (159 RYGB and 107 SG) with 96% follow-up after 4 years. The mean age of the cohort was 51.4 years; the majority of patients were male (59%) and Caucasian (69%). RYGB patients had a greater mean body mass index and were more likely to have hypertension or hypertriglyceridemia. RYGB was associated with a similar metabolic syndrome remission to SG (37.6% vs 26.8%; =0.09). The percentage of weight loss was 26.5% after RYGB and 10.8% after SG at 4 years post operation (<0.01). Predictors of metabolic syndrome persistence were male gender, type 2 diabetes, and low high-density lipoprotein. While both the operations were associated with similar mortality (RYGB 4.4%, SG 2.8%; =0.74), RYGB was associated with a greater rate of morbidity.
RYGB and SG seem to be associated with similar remission rates of metabolic syndrome at 4 years. RYGB yields greater weight loss with greater medium-term complications.
减重手术已知可减轻体重并降低合并症的患病率，但关于胃旁路术（RYGB）和袖状胃切除术（SG）对术后4年综合结局代谢综合征缓解的差异影响，几乎没有证据。本研究的目的是确定RYGB和SG对退伍军人代谢综合征的有效性。
我们回顾性分析了2003年至2012年在达拉斯退伍军人事务医疗中心接受SG和RYGB的连续患者。我们确定了两种手术对代谢综合征缓解、其各个组成部分以及中期发病率和死亡率的影响。使用倾向匹配进行敏感性分析。
共确定了266例患者（159例RYGB和107例SG），4年后随访率为96%。队列的平均年龄为51.4岁；大多数患者为男性（59%）和白种人（69%）。RYGB患者的平均体重指数更高，更有可能患有高血压或高甘油三酯血症。RYGB与SG的代谢综合征缓解率相似（37.6%对26.8%；P=0.09）。术后4年，RYGB后的体重减轻百分比为26.5%，SG后为10.8%（P<0.01）。代谢综合征持续存在的预测因素为男性、2型糖尿病和低高密度脂蛋白。虽然两种手术的死亡率相似（RYGB为4.4%，SG为2.8%；P=0.74），但RYGB的发病率更高。
RYGB和SG在4年时似乎与代谢综合征的缓解率相似。RYGB减重更多，但中期并发症更多。
