Department of Human Pathology of Adult and Evolutive Age, University of Messina, Messina, Italy.
Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.
Obes Surg. 2019 Sep;29(9):3062-3070. doi: 10.1007/s11695-019-04019-8.
One Anastomosis Gastric Bypass-Mini Gastric Bypass (OAGB-MGB) is rapidly gaining popularity and is currently being performed by an increasing number of bariatric surgeons worldwide. However, excessive postoperative weight loss and malnutrition still remain a major concern regarding this procedure. The aim of this observational retrospective study was to investigate whether a tailored biliopancreatic limb (BPL) length relative to small bowel length (SBL) is superior to a fixed BPL length of 200 cm in terms of weight loss results and nutritional deficiencies in morbidly obese patients 1 year following OAGB-MGB.
Sixty-four patients who underwent OAGB-MGB were divided into two consecutive groups depending on the BPL length used: fixed 200-cm BPL and tailored BPL groups. Anthropometric measurements (%EWL, TWL, %TWL) and nutritional parameters (vitamin A, vitamin D, vitamin B, serum iron, serum albumin, total protein) were compared between the two groups at 1-year follow-up.
No statistically significant differences were observed between the patients in two groups in terms of %EWL, TWL, %TWL. The number of patients with deficiencies of vitamin A (p = 0.030), vitamin D (p = 0.020), and albumin (p = 0.030) was significantly higher in fixed 200-cm BPL group as compared with tailored BPL group, 1 year following OAGB-MGB. No statistically significant differences were seen between the patients in two groups in terms of vitamin B iron, and total protein deficiencies.
Tailoring BPL length by bypassing about 40% of the SBL seems to be safe and effective. According to preliminary results of this study, a tailored BPL length relative to SBL is even likely to be superior to the fixed 200-cm BPL as it is associated with less nutritional deficiencies while providing similar weight loss results. Further randomized studies with larger sample sizes and longer follow-up periods are necessary to confirm the primary results of this study.
单吻合口胃旁路-迷你胃旁路术（OAGB-MGB）正在迅速普及，目前全球越来越多的减重外科医生正在开展该手术。然而，术后体重过度减轻和营养不良仍然是该手术的主要关注点。本观察性回顾性研究旨在探讨相对于 200cm 固定胆胰支（BPL）长度，根据小肠长度（SBL）量身定制 BPL 长度是否能在 OAGB-MGB 术后 1 年改善肥胖患者的减重效果和营养缺陷。
根据使用的 BPL 长度，将 64 例接受 OAGB-MGB 的患者分为两组：固定 200cm BPL 组和量身定制 BPL 组。比较两组患者术后 1 年的体重减轻百分比（%EWL）、体重减轻绝对值（TWL）、总体重减轻百分比（%TWL）和营养参数（维生素 A、维生素 D、维生素 B、血清铁、血清白蛋白、总蛋白）。
两组患者的%EWL、TWL、%TWL 无统计学差异。术后 1 年，固定 200cm BPL 组维生素 A（p=0.030）、维生素 D（p=0.020）和白蛋白（p=0.030）缺乏的患者数量明显多于量身定制 BPL 组。两组患者在维生素 B、铁和总蛋白缺乏方面无统计学差异。
通过旁路约 40%的 SBL 来定制 BPL 长度似乎是安全有效的。根据本研究的初步结果，相对于固定 200cm BPL，量身定制的 BPL 长度可能更优越，因为它与较少的营养缺陷相关，同时提供相似的减重效果。需要进一步开展随机研究，样本量更大、随访时间更长，以证实本研究的主要结果。
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