Center for Weight Loss and Health Management, E-DA Dachang Hospital, Kaohsiung, Taiwan; Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan.
Department of Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan; Department of Surgery, College of Medicine, Taif University, Saudi Arabia.
Surg Obes Relat Dis. 2019 Oct;15(10):1712-1718. doi: 10.1016/j.soard.2019.08.010. Epub 2019 Aug 21.
Laparoscopic one (single)-anastomosis gastric bypass (OAGB) is an effective and durable treatment for morbidly obese patients. However, the ideal length of the small bowel bypass remains controversial.
The study aimed to report the clinical results of using a tailored bypass based on the total length of the small bowel.
Academic medical center.
Since 2005, we have performed OAGB with tailored limb according to preoperative body mass index. From July 2014, we modified our technique, measuring the whole small bowel length to keep the common channel at least 400-cm long. Data from 470 patients treated with the new technique (Group II) were compared with those of a matched group treated with tailored bypass only (Group I). The preoperative clinical data and outcomes were analyzed. All clinical data were prospectively collected and stored.
Both groups had similar clinical profiles at baseline. All procedures were completed laparoscopically. Group II had a significant longer operation time (161.9 versus 122.6 min; P < .001), but shorter hospital stay (2.9 versus 5.3 d; P < .001) and lower complication rate (.2% versus 1.5%; P = .002) than Group I. One year after surgery, the mean body mass index (27.4 versus 26.8 kg/m; P = .244), percent total weight loss (32.0% versus 34.0%; P = .877), and diabetes remission rate (84.7% versus 84.1%; P = .876) were comparable between the 2 groups. However, Group II patients had a significantly lower incidence of anemia (5.9% versus 11.1%; P < .001), secondary hyperparathyroidism (21.7% versus 33.8%; P < .001) and hypoalbuminemia (1.5% versus 2.8%; P < .001) than did Group I.
Routine measurement of the whole bowel length to keep the common channel at least 400-cm long may reduce the incidence of malnutrition after OAGB with tailored limb bypass, without compromising efficacy in weight loss and diabetes resolution.
腹腔镜单吻合口胃旁路术（OAGB）是治疗病态肥胖患者的有效且持久的方法。然而，旁路小肠的理想长度仍存在争议。
本研究旨在报告根据小肠总长度进行个体化旁路的临床结果。
学术医疗中心。
自 2005 年以来，我们根据术前体重指数进行个体化 OAGB。自 2014 年 7 月起，我们修改了手术技术，测量整个小肠长度以确保共同通道至少 400cm 长。将新手术技术（II 组）治疗的 470 例患者的数据与仅采用个体化旁路治疗的匹配组（I 组）进行比较。分析术前临床数据和结果。所有临床数据均前瞻性收集和存储。
两组基线临床特征相似。所有手术均经腹腔镜完成。II 组手术时间明显较长（161.9 分钟 vs 122.6 分钟；P<0.001），但住院时间较短（2.9 天 vs 5.3 天；P<0.001），并发症发生率较低（0.2% vs 1.5%；P=0.002）。术后 1 年，两组间平均体重指数（27.4 千克/米 2 vs 26.8 千克/米 2；P=0.244）、体质量总减轻百分比（32.0% vs 34.0%；P=0.877）和糖尿病缓解率（84.7% vs 84.1%；P=0.876）相当。然而，II 组贫血（5.9% vs 11.1%；P<0.001）、继发性甲状旁腺功能亢进（21.7% vs 33.8%；P<0.001）和低白蛋白血症（1.5% vs 2.8%；P<0.001）的发生率明显低于 I 组。
常规测量整个肠段长度以确保共同通道至少 400cm 长可能会减少个体化旁路 OAGB 术后营养不良的发生率，同时不影响减重和糖尿病缓解的效果。
