Department of Minimal Access Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS, UK.
Ashford and St Peter's Hospital, Kent, UK.
Obes Surg. 2018 Oct;28(10):3020-3027. doi: 10.1007/s11695-018-3322-9.
Obesity surgery mortality risk scoring system (OS-MRS) classifies patients into high, intermediate and low risk, based on age, body mass index, sex and other comorbidities such as hypertension and history of pulmonary embolism. High-risk patients not only have a higher mortality but are more likely to develop post-operative complications necessitating intervention or prolonged hospital stay following bariatric surgery. Endoscopically placed duodenal-jejunal bypass sleeve (Endobarrier) has been designed to achieve weight loss and improve glycaemic control in morbidly obese patients with clinically proven effectiveness. The aim of this study was to assess if pre-operative insertion of endobarrier in high-risk patients can decrease morbidity and length of stay after bariatric surgery.
Between 2012 and 2014, a cohort of 11 high-risk patients had an Endobarrier inserted (E&BS group) for 1 year prior to definitive bariatric surgery. These patients were compared against a similar group undergoing primary bariatric surgery (PBS group) during same duration. The two groups were matched for age, gender, body mass index, comorbidities, surgical procedure and OS-MRS using propensity score matching. Outcome measures included operative time, morbidity, length of stay, intensive therapy unit (ITU) stay, readmission rate, percentage excess weight loss (%EWL) and percentage total weight loss (%TWL).
Patient characteristics and OS-MRS were similar in both groups (match tolerance 0.1). There was no significant difference in total length of stay, readmission rate, %EWL and %TWL. Operative time, ITU stay, post-operative complications and severity of complications were significantly less in the E&BS group (p < 0.05) with significant likelihood of planned ITU admissions in the PBS group (p < 0.05).
Endobarrier could be considered as a pre bariatric surgical intervention in high-risk patients. It may result in improved post-operative outcomes in high-risk bariatric patients.
肥胖手术死亡率风险评分系统（OS-MRS）根据年龄、体重指数、性别和其他合并症（如高血压和肺栓塞病史）将患者分为高、中、低风险。高危患者不仅死亡率更高，而且更有可能在肥胖症手术后出现并发症，需要干预或延长住院时间。内镜放置的十二指肠-空肠旁路袖套（Endobarrier）旨在通过临床证实的有效性来实现病态肥胖患者的体重减轻和改善血糖控制。本研究旨在评估在高危患者中术前插入 Endobarrier 是否可以降低肥胖症手术后的发病率和住院时间。
2012 年至 2014 年间，一组 11 名高危患者在接受确定性肥胖症手术前 1 年插入了 Endobarrier（E&BS 组）。这些患者与同一时期接受原发性肥胖症手术（PBS 组）的类似组进行了比较。两组通过倾向评分匹配，在年龄、性别、体重指数、合并症、手术程序和 OS-MRS 方面进行了匹配。主要观察指标包括手术时间、发病率、住院时间、重症监护病房（ITU）停留时间、再入院率、体重减轻百分比（%EWL）和总体重减轻百分比（%TWL）。
两组患者的患者特征和 OS-MRS 相似（匹配容忍度 0.1）。总住院时间、再入院率、%EWL 和 %TWL 无显著差异。E&BS 组的手术时间、ITU 停留时间、术后并发症和并发症严重程度明显较低（p<0.05），PBS 组的 ITU 计划入院率显著较高（p<0.05）。
Endobarrier 可被视为高危患者的肥胖症手术前干预措施。它可能会改善高危肥胖症患者的术后结果。
