University Hospital Cleveland Medical Center / Case Western Reserve University School of Medicine, Cleveland, OH, USA; Department of General, Oncologic, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warszawa, Poland.
University Hospital Cleveland Medical Center / Case Western Reserve University School of Medicine, Cleveland, OH, USA; General Surgery Department, Faculty of Medicine, Menoufia University, Al Minufya, Egypt.
Surg Obes Relat Dis. 2018 Sep;14(9):1276-1282. doi: 10.1016/j.soard.2018.04.008. Epub 2018 Apr 23.
An increase in the prevalence of obesity and longer life expectancy has resulted in an increased number of candidates over the age of 60 who are pursuing a bariatric procedure.
The aim of this study was to assess the safety of laparoscopic Roux-Y gastric bypass (LRYGB) compared to laparoscopic sleeve gastrectomy (LSG) in patients aged 60 years or older.
University Hospital, United States METHODS: Preoperative characteristics and 30-day outcomes from the MBSAQIP 2015 were selected for all patients aged 60 years or older who underwent a LSG or LRYGB. LRYGB cases were closely matched (1:1) with LSG patients by age (±1 year), BMI (±1 kg/m2), gender, preoperative steroid or immunosuppressant use, preoperative functional health status and comorbidities including: diabetes, gastroesophageal reflux disease, hypertension, hyperlipidemia, venous stasis, sleep apnea and history of severe chronic obstructive pulmonary disease.
A 3371 matched pairs were included in the study. The mean operative time in LRYGB was significantly longer in comparison to LSG patients (122 vs 84 min., P<0.001). Patients after LRYGB had a significantly increased anastomotic leakage rate (1.01% vs 0.47 %, p = 0.011), 30-day readmission rate (6.08% vs 3.74%, p < 0.001) and 30-day reoperation rate (2.49% vs 0.89%, p < 0.001) The length of hospital stay was longer in LRYGB. Mortality and bleed rate was comparable.
LRYGB and LSG in patients aged 60 years or older are relatively safe in the short term with an acceptable complication rate and low mortality. However, LRYGB is more challenging and is associated with significantly increased rates of leakage events, 30-day reoperation, 30-day readmission, longer operative time and longer hospital stay.
肥胖患病率的增加和预期寿命的延长导致寻求减重手术的 60 岁以上患者人数增加。
本研究旨在评估腹腔镜 Roux-Y 胃旁路术（LRYGB）与腹腔镜袖状胃切除术（LSG）在 60 岁或以上患者中的安全性。
美国大学医院
从 MBSAQIP 2015 中选择所有 60 岁或以上接受 LSG 或 LRYGB 的患者的术前特征和 30 天结果。通过年龄（±1 岁）、BMI（±1kg/m2）、性别、术前使用类固醇或免疫抑制剂、术前功能健康状况和合并症（包括糖尿病、胃食管反流病、高血压、高血脂、静脉淤滞、睡眠呼吸暂停和严重慢性阻塞性肺疾病史）对 LRYGB 病例进行 1:1 匹配（LSG 患者）。
本研究纳入了 3371 对匹配的患者。LRYGB 的手术时间明显长于 LSG 患者（122 分钟 vs 84 分钟，P<0.001）。LRYGB 后吻合口漏的发生率（1.01% vs 0.47%，p=0.011）、30 天再入院率（6.08% vs 3.74%，p<0.001）和 30 天再次手术率（2.49% vs 0.89%，p<0.001）均显著升高。LRYGB 的住院时间较长。死亡率和出血率相当。
60 岁或以上患者的 LRYGB 和 LSG 在短期内相对安全，并发症发生率可接受，死亡率低。然而，LRYGB 更具挑战性，与明显增加的漏液事件、30 天再次手术、30 天再入院、手术时间延长和住院时间延长相关。
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