Department of Visceral Surgery, University Hospital, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Division of Diabetology, Endocrinology and Metabolism, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Ann Surg. 2018 Dec;268(6):1019-1025. doi: 10.1097/SLA.0000000000002538.
The aim of this paper is to report, with a high follow-up rate, 10-year results in a large cohort of patients after Roux-en-Y gastric bypass (RYGBP) done essentially by laparoscopy.
RYGBP has been performed for 50 years, including 20 years by laparoscopy, yet very few long-term results have been reported, mostly after open surgery.
Prospective bariatric database established since the introduction of bariatric surgery. Retrospective data analysis on weight loss, long-term complications, quality of life, and comorbidities.
In all, 658 consecutive patients (515 women/143 men) were included: 554 with primary RYGBP, 104 with reoperative RYGBP. There was 1 (0.15%) postoperative death. Thirty-two (5%) patients died during follow-up from causes unrelated to surgery. Ten years after primary RYGBP, patients lost 28.6 ± 10.5% of their initial weight, corresponding to a mean of 13.2 body mass index (BMI) units. Among them, 72.8% achieved a BMI <35. Weight loss ≥20% was seen in 80.3% and <10% in 3.9% of patients. Results were similar in patients undergoing primary or reoperative RYGBP, but were better in patients who were initially less obese (BMI <50 kg/m) than in superobese patients. Quality of life and comorbidities significantly improved with 80% resolution or improvement of metabolic comorbidities. All patients required supplementations, and 14.6% required long-term reoperation.
RYGBP provides long-term satisfactory weight loss up to 10 years, and significantly improves quality of life and comorbidities. Long-term complications requiring reoperation can develop. Mineral and vitamin supplementation are universally necessary. Other more effective surgical options should be discussed in patients with very severe obesity.
本文旨在报告，通过高随访率，对大量接受腹腔镜基本方法施行的 Roux-en-Y 胃旁路术（RYGBP）患者进行 10 年的结果。
RYGBP 已施行 50 年，其中腹腔镜手术施行 20 年，但很少有长期结果报告，大多数是开放手术后的结果。
在开展减重手术以来建立的前瞻性减重数据库，对减重、长期并发症、生活质量和合并症进行回顾性数据分析。
共纳入 658 例连续患者（515 例女性/143 例男性）：554 例初次 RYGBP，104 例再次 RYGBP。术后有 1 例（0.15%）死亡。32 例（5%）患者在随访期间因与手术无关的原因死亡。初次 RYGBP 后 10 年，患者体重减轻了 28.6±10.5%，相当于平均体重指数（BMI）降低了 13.2 个单位。其中，72.8%的患者 BMI<35。80.3%的患者减重>20%，3.9%的患者减重<10%。初次 RYGBP 和再次 RYGBP 的患者结果相似，但初始肥胖程度较低（BMI<50kg/m）的患者比超级肥胖患者效果更好。生活质量和合并症显著改善，80%的代谢合并症得到缓解或改善。所有患者均需要补充，14.6%需要长期再次手术。
RYGBP 可长期提供令人满意的减重效果，长达 10 年，并显著改善生活质量和合并症。可能会出现需要再次手术的长期并发症。普遍需要补充矿物质和维生素。对于非常严重肥胖的患者，应讨论其他更有效的手术选择。
