Cottam Austin, Cottam Daniel, Zaveri Hinali, Cottam Samuel, Surve Amit, Medlin Walter, Richards Christina
Bariatric Medicine Institute, 1046 East 100 South, Salt Lake City, UT, 84102, USA.
Obes Surg. 2018 Sep;28(9):2894-2902. doi: 10.1007/s11695-018-3309-6.
For many years, the Roux-en-Y Gastric Bypass (RYGB) was considered a good balance of complications and weight loss. According to several short-term studies, single anastomosis duodenal switch or stomach intestinal pylorus sparing surgery (SIPS) offers similar weight loss to RYGB with fewer complications and better diabetes resolution. No one has substantiated mid-term complication and nutritional differences between these two procedures. This paper seeks to compare complication and nutritional outcomes between RYGB and SIPS.
A retrospective analysis of 798 patients who either had SIPS or RYGB from 2010 to 2016. Complications were gathered for each patient. Nutritional outcomes were measured for each group at 1, 2, and 3 years. Regression analysis was applied to interpolate each patient's weight at 3, 6, 9, 12, 18, 24, and 36 months. These were then compared with t tests, Fisher's exact tests, and chi-squared tests.
RYGB and SIPS have statistically similar weight loss at 3, 6, 9, 12, and 36 months. They statistically differ at 18 and 24 months. At 36 months, there is a trend for weight loss difference. There were only statistical differences in nutritional outcomes between the two procedures with calcium at 1 and 3 years and vitamin D at 1 year. There were statistically significantly more long-term class IIIb-V complications, class I-IIIa complications, reoperations, ulcers, small bowel obstructions, nausea, and vomiting with the RYGB than the SIPS.
With comparable weight loss and nutritional outcomes, SIPS has fewer short- and long-term complications than RYGB and better type 2 diabetes resolution rates.
多年来，Roux-en-Y胃旁路术（RYGB）被认为是并发症与体重减轻之间的良好平衡。根据多项短期研究，单吻合口十二指肠转位术或保留胃幽门的胃小肠吻合术（SIPS）与RYGB相比，体重减轻效果相似，但并发症更少，糖尿病缓解情况更好。尚无研究证实这两种手术在中期并发症和营养方面的差异。本文旨在比较RYGB和SIPS在并发症和营养方面的结果。
对2010年至2016年期间接受SIPS或RYGB手术的798例患者进行回顾性分析。收集每位患者的并发症情况。在术后1年、2年和3年测量每组的营养指标。应用回归分析来推算每位患者在术后3个月、6个月、9个月、12个月、18个月、24个月和36个月时的体重。然后将这些体重与t检验、Fisher精确检验和卡方检验进行比较。
RYGB和SIPS在术后3个月、6个月、9个月、12个月和36个月时的体重减轻情况在统计学上相似。在术后18个月和24个月时，二者在统计学上存在差异。在术后36个月时，体重减轻差异存在一种趋势。两种手术在营养指标方面仅在术后1年和3年的钙以及术后1年的维生素D上存在统计学差异。与SIPS相比，RYGB在长期的IIIb-V级并发症、I-IIIa级并发症、再次手术、溃疡、小肠梗阻、恶心和呕吐方面在统计学上显著更多。
在体重减轻和营养指标相当的情况下，SIPS比RYGB的短期和长期并发症更少，2型糖尿病缓解率更高。
