Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
J Am Coll Surg. 2019 Jun;228(6):893-901.e1. doi: 10.1016/j.jamcollsurg.2019.01.021. Epub 2019 Feb 21.
Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most effective therapies for obesity and may have beneficial effects on the immune system. Therefore, we compared RYGB vs SG outcomes in patients with inflammatory bowel disease (IBD).
In this retrospective cohort study, we identified 54 patients with either Crohn's disease (CD; n = 31) or ulcerative colitis (UC; n = 23), diagnosed before bariatric surgery, between 2000 and 2017. Nineteen patients underwent RYGB and 35 patients underwent SG.
Patients presenting for RYGB and SG were of similar age (46.2 ± 9.5 years vs 47.2 ± 12.3 years), preoperative BMI (48.5 ± 7.7 kg/m vs 44.9 ± 7.3 kg/m) and IBD status, as measured by medications. Both operations led to significant weight loss at 1 year. After RYGB and SG, there were no significant differences in the proportion of patients with UC who had improved (27% vs 8%), unchanged (64% vs 92%), or worse (9% vs 0%) IBD medication requirements, respectively. Similar analysis in the patients with CD showed no significant differences in the proportion who had improved (37.5% vs 44%), or unchanged (25% vs 52%) IBD-medication requirements after RYGB and SG, respectively. However, there was a significant difference in the proportion of patients who had worsened CD after RYGB compared with SG (37.5% vs 4%; p = 0.016). There was a greater rate of surgical complications after RYGB compared to SG (26% vs. 3%; p = 0.02).
A sizable proportion of patients experienced improvements in IBD post-bariatric surgery. However, in CD patients, RYGB was associated with a significantly greater number of patients with increased IBD-medication requirements. Sleeve gastrectomy led to less weight loss, but had a lower rate of severe complications compared with RYGB. In patients with IBD, and particularly CD, SG may be the safer surgery.
Roux-en-Y 胃旁路术（RYGB）和袖状胃切除术（SG）是治疗肥胖症最有效的疗法，并且可能对免疫系统有有益的影响。因此，我们比较了炎症性肠病（IBD）患者接受 RYGB 和 SG 的结果。
在这项回顾性队列研究中，我们确定了 2000 年至 2017 年间接受过减肥手术的 54 名 IBD 患者，其中包括 31 名克罗恩病（CD）患者和 23 名溃疡性结肠炎（UC）患者。19 名患者接受 RYGB，35 名患者接受 SG。
RYGB 和 SG 患者的年龄（46.2 ± 9.5 岁 vs 47.2 ± 12.3 岁）、术前 BMI（48.5 ± 7.7 kg/m 2 vs 44.9 ± 7.3 kg/m 2）和 IBD 状态（通过药物治疗衡量）相似。两种手术均在 1 年内导致显著的体重减轻。在接受 RYGB 和 SG 后，UC 患者中改善（27% vs 8%）、不变（64% vs 92%）或恶化（9% vs 0%）IBD 药物需求的比例没有显著差异。在 CD 患者中的类似分析显示，接受 RYGB 和 SG 后，改善（37.5% vs 44%）或不变（25% vs 52%）IBD 药物需求的比例没有显著差异。然而，RYGB 后 CD 患者恶化的比例明显高于 SG（37.5% vs 4%；p=0.016）。RYGB 后手术并发症的发生率明显高于 SG（26% vs. 3%；p=0.02）。
减肥手术后相当一部分 IBD 患者的病情得到改善。然而，在 CD 患者中，RYGB 与更多需要增加 IBD 药物治疗的患者相关。袖状胃切除术导致的体重减轻较少，但与 RYGB 相比，严重并发症的发生率较低。在 IBD 患者中，特别是 CD 患者，SG 可能是更安全的手术。
