Vitiello Antonio, Angrisani Luigi, Santonicola Antonella, Iovino Paola, Pilone Vincenzo, Forestieri Pietro
Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy.
General, Laparoscopic and Emergency Surgery Unit, San Giovanni Bosco Hospital, Naples, Italy.
World J Surg. 2019 Mar;43(3):758-762. doi: 10.1007/s00268-018-4847-8.
The American Society of Metabolic and Bariatric Surgery (ASMBS) and the International Federation of Surgery for Obesity (IFSO) have both stated that bariatric surgery (BS) should not be denied in Class I patients. However, lifestyle intervention (LI), such as diet plus gym programs, is still considered the preferred approach for subjects with a BMI ranging from 30 to 35 kg/m. The aim of this study was to retrospectively compare results of LI and BS in patients in Class I obesity.
Retrospective analysis of prospective maintained databases of two centers for the "Interdisciplinary Treatment of Obesity" was performed. All patients in Class I obesity and follow-up >7 years were included in the study. Subjects were divided into two groups: BS group that included patients who had undergone surgery and LI group that included patients who underwent lifestyle intervention (LI). Percentage of excess body mass index loss (%EBMIL) and comorbidities remission were recorded.
Seventy-six patients were included in the study. Fifty-six subjects were submitted to surgery (BS group); 20 subjects were treated with nonsurgical approach (LI group). In BS group, 34 underwent laparoscopic adjustable gastric band, 13 laparoscopic sleeve gastrectomy (LSG), and 9 laparoscopic Roux-en-Y gastric bypass. EWL% resulted significantly higher in BS group at 1, 3, 5, 7 and 10 years (p < 0.01).
Bariatric surgery is more effective than LI for patients in Class I obesity. Due to its versatility, low-risk profile and high-effectiveness LSG could be the standard intervention for these patients.
美国代谢与减重外科学会（ASMBS）和国际肥胖外科学会联合会（IFSO）均指出，不应拒绝为I类患者实施减重手术（BS）。然而，生活方式干预（LI），如饮食加健身计划，仍被认为是体重指数（BMI）在30至35kg/m²之间的受试者的首选方法。本研究的目的是回顾性比较I类肥胖患者中LI和BS的效果。
对两个“肥胖症跨学科治疗”中心前瞻性维护的数据库进行回顾性分析。纳入所有I类肥胖且随访时间>7年的患者。受试者分为两组：接受手术的患者组成的BS组和接受生活方式干预（LI）的患者组成的LI组。记录多余体重指数降低百分比（%EBMIL）和合并症缓解情况。
76例患者纳入研究。56例受试者接受了手术（BS组）；20例受试者接受非手术治疗（LI组）。在BS组中，34例行腹腔镜可调节胃束带术，13例行腹腔镜袖状胃切除术（LSG），9例行腹腔镜Roux-en-Y胃旁路术。在1年、3年、5年、7年和10年时，BS组的EWL%显著更高（p<0.01）。
对于I类肥胖患者，减重手术比LI更有效。由于其多功能性、低风险特征和高效性，LSG可能是这些患者的标准干预措施。
