Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Rotary Building at Indiana University, 702 Rotary Circle, Suite 022, Indianapolis, IN, 46202, USA.
Obes Surg. 2020 Mar;30(3):889-894. doi: 10.1007/s11695-019-04275-8.
Most patients pursuing bariatric surgery undergo mandated preoperative weight management programs. The purpose of this study was to assess whether preoperative mandated weight loss goals lead to improved perioperative morbidity, postoperative weight loss, and resolution of comorbidities.
Data from patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB), and laparoscopic sleeve gastrectomy (LSG) between October 2012 and October of 2015 was reviewed. Patients were divided in two groups: those with BMI of 35-45 were not required to achieve a weight loss goal prior to surgery (no-WLG group) while those with BMI > 45 were given a weight loss goal proportionate to their weight (WLG group). Body mass index (BMI), history of diabetes mellitus type-II (DM-II), hypertension (HTN), hyperlipidemia (HLD), and obstructive sleep apnea (OSA) were recorded at baseline and 4 years postoperatively. Length of hospital stay (LOS) and reinterventions were considered proxies for postoperative morbidity.
A total of 776 patients, 81.4% LRYGB, were included in the study (age 45.1 ± 11.9). There was no difference in %ΔBMI, DM-II, HDL, HTN, LOS, or reinterventions among the two groups at 4 years postoperatively in both LRNY and LSG patients. This lack of difference persisted even when patients with similar BMI (43-45 vs 45.01-47) were compared.
WLG group did not have decreased perioperative morbidity, nor improved weight loss and comorbidity resolution 4 years after surgery. While these findings should also be confirmed by multicenter trials, they question the value of mandated WLG prior to bariatric surgery as they seem ineffective and may limit patient access to surgery.
大多数接受减重手术的患者都要接受强制性术前体重管理计划。本研究的目的是评估术前强制性减肥目标是否会降低围手术期发病率，术后体重减轻以及并发症的解决。
回顾了 2012 年 10 月至 2015 年 10 月期间接受腹腔镜胃旁路术（LRYGB）和腹腔镜袖状胃切除术（LSG）的患者的数据。患者分为两组：BMI 为 35-45 的患者不需要在手术前达到减肥目标（无 WLG 组），而 BMI>45 的患者则按照其体重的比例设定减肥目标（WLG 组）。记录基线和术后 4 年时的体重指数（BMI）、2 型糖尿病（DM-II）、高血压（HTN）、高血脂（HLD）和阻塞性睡眠呼吸暂停（OSA）的病史。住院时间（LOS）和再干预被认为是术后发病率的替代指标。
本研究共纳入 776 例患者（81.4%为 LRYGB），年龄为 45.1±11.9 岁。LRYGB 和 LSG 患者术后 4 年时，两组之间的 BMI 变化百分比、DM-II、HDL、HTN、LOS 或再干预均无差异。即使比较 BMI 相似的患者（43-45 与 45.01-47）时，这种差异仍然存在。
WLG 组在术后 4 年时并没有降低围手术期发病率，也没有改善体重减轻和并发症的解决。虽然这些发现也应该通过多中心试验来证实，但它们对减重手术前强制性 WLG 的价值提出了质疑，因为它们似乎无效，并且可能限制患者接受手术的机会。
