Division of Digestive Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.
Nutrition. 2019 Jan;57:290-299. doi: 10.1016/j.nut.2018.05.024. Epub 2018 Jun 18.
Obesity is a pandemic health problem. Bariatric surgery is the only efficient method for long-term effective weight loss in subjects with severe obesity. Laparoscopic adjustable gastric banding (LAGB) has been widely applied for weight loss. However, a novel technique called laparoscopic adjustable gastric banded plication (LAGBP) has been proposed as an alternative to LAGB. Surgeons generally consider LAGBP to have a relative advantage on weight loss than that derived from LAGB. This initial study applied various biostatistical models and considered a relative longer observation period to compare the effects of LAGB and LAGBP.
A total of 340 obese patients (290 who underwent LAGB and 50 who underwent LAGBP) with a body mass index of ≥35 kg/m and ages 20 to 55 y were recruited from the Division of General Surgery, Taipei Medical University Hospital in Taipei, Taiwan and observed for 24 to 36 mo postoperatively.
Both surgical procedures resulted in significant weight loss, amelioration of poor glucose metabolism, and decreased serum triacylglycerol levels. However, the trend analysis showed no significant differences between the postoperative effects of LAGB and LAGBP (P for trend = 0.21 for body mass index reduction, 0.13 for total body fat percentage reduction, 0.25-0.29 for glucose metabolism amelioration, and 0.10-0.29 for blood pressure improvement). Improvements in serum total cholesterol and high-density lipoprotein cholesterol levels were observed after LAGB only and LAGBP only, respectively, at 24 mo postoperatively. The Framingham Coronary Heart Disease Risk score also showed significant decrease for patients who underwent LAGB and LAGBP.
Both LAGB and LAGBP demonstrated comparable efficacy in reducing body weight and improving metabolic parameters in a 24 to 36 mo follow-up period. LABG showed the ability to reduce systolic blood pressure and LAGBP exhibited triacylglycerol-lowering effects. A longer observational period is needed in future studies.
肥胖是一种全球性的健康问题。减重手术是严重肥胖患者长期有效减肥的唯一有效方法。腹腔镜可调节胃束带术（LAGB）已广泛应用于减肥。然而，一种称为腹腔镜可调节胃束带折叠术（LAGBP）的新技术已被提出作为 LAGB 的替代方法。外科医生通常认为 LAGBP 在减肥方面相对于 LAGB 具有相对优势。这项初步研究应用了各种生物统计学模型，并考虑了相对较长的观察期，以比较 LAGB 和 LAGBP 的效果。
从台湾台北市台北医学大学附属医院普通外科共招募了 340 名肥胖患者（290 名接受 LAGB，50 名接受 LAGBP），体重指数≥35 kg/m2，年龄 20 至 55 岁，术后观察 24 至 36 个月。
两种手术均导致体重显著减轻，改善了不良的葡萄糖代谢，并降低了血清三酰甘油水平。然而，趋势分析显示 LAGB 和 LAGBP 的术后效果无显著差异（体重指数降低的趋势分析 P=0.21，全身脂肪百分比降低的趋势分析 P=0.13，葡萄糖代谢改善的趋势分析 P=0.25-0.29，血压改善的趋势分析 P=0.10-0.29）。仅在术后 24 个月时，LAGB 和 LAGBP 分别观察到血清总胆固醇和高密度脂蛋白胆固醇水平的改善。Framingham 冠心病风险评分也显示 LAGB 和 LAGBP 患者的评分显著降低。
在 24 至 36 个月的随访期间，LAGB 和 LAGBP 均显示出相似的疗效，可减轻体重并改善代谢参数。LAGB 显示出降低收缩压的能力，而 LAGBP 则表现出降低三酰甘油的作用。未来的研究需要更长的观察期。
