Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar São João, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
Faculty of Medicine of University of Porto, Porto, Portugal.
Obes Surg. 2019 Jan;29(1):281-291. doi: 10.1007/s11695-018-3519-y.
Super obesity (BMI ≥ 50 kg/m) is associated with significant morbidity and mortality. The best procedure to treat super obesity is not completely established. Our aim was to compare the effectiveness of bariatric procedures (adjustable gastric band [AGB], Roux-en-Y gastric bypass [RYGB], sleeve gastrectomy [SG]) in super obesity.
Retrospective observational study of super obese patients who underwent bariatric surgery. Data was assessed preoperatively and in the 1st and 2nd years of follow-up.
We evaluated 213 individuals, 77.9% female, age of 43.38 ± 11.49 years, and preoperative BMI of 54.53 ± 4.54 kg/m; 19 submitted to AGB, 127 to RYGB, and 67 to SG. In the pre-surgical assessment, there were no significant differences in age, anthropometric parameters, blood pressure, glycemic profile, and lipid profile between the three surgical groups. The percentage of excess weight loss (%EWL) in the 1st year was 67.58% in RYGB, 58.74% in SG, and 38.71% in AGB (p < 0.001), and the percentage of total weight loss (%TWL) was 36.29%, 31.59%, and 21.07%, respectively (p < 0.001). Two years after surgery (n = 147; follow-up rate of 69%), the %EWL and %TWL were significantly higher in the RYGB group (p < 0.001). RYGB had a higher success rate (%EWL ≥ 50% and %TWL ≥ 20%) in both years of follow-up (p < 0.001). In multiple linear regression, after adjusting for other covariates, RYGB was the only strong predictive factor of %EWL and %TWL (p < 0.001).
RYGB proved to be more effective in super obesity. The beneficial effects in weight loss were evident both 1 and 2 years after the procedure, regardless of pre-surgical anthropometric characteristics.
超级肥胖（BMI≥50kg/m²）与显著的发病率和死亡率相关。治疗超级肥胖的最佳方法尚未完全确定。我们的目的是比较减重手术（可调胃束带[AGB]、胃旁路术[RYGB]、袖状胃切除术[SG]）在超级肥胖中的疗效。
对接受减重手术的超级肥胖患者进行回顾性观察性研究。数据在术前和术后 1 年和 2 年进行评估。
我们评估了 213 名患者，其中 77.9%为女性，年龄 43.38±11.49 岁，术前 BMI 为 54.53±4.54kg/m²；19 人接受 AGB，127 人接受 RYGB，67 人接受 SG。在术前评估中，三组手术患者的年龄、人体测量参数、血压、血糖谱和血脂谱均无显著差异。RYGB 组术后 1 年的体重减轻百分比（%EWL）为 67.58%，SG 组为 58.74%，AGB 组为 38.71%（p<0.001），总体重减轻百分比（%TWL）分别为 36.29%、31.59%和 21.07%（p<0.001）。术后 2 年（n=147；随访率 69%），RYGB 组的%EWL 和%TWL 显著更高（p<0.001）。RYGB 在两年的随访中都具有更高的成功率（%EWL≥50%和%TWL≥20%）（p<0.001）。在多元线性回归中，在调整其他协变量后，RYGB 是%EWL 和%TWL 的唯一强预测因素（p<0.001）。
RYGB 对超级肥胖症更有效。术后 1 年和 2 年，体重减轻的有益效果明显，与术前人体测量特征无关。
