Kaiser Permanente Washington Health Research Institute, Seattle, WA.
Kaiser Permanente Southern California, Pasadena, CA.
Ann Surg. 2021 Dec 1;274(6):e1269-e1276. doi: 10.1097/SLA.0000000000003826.
To investigate weight trajectories among patients with severe obesity undergoing sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and nonsurgical treatment.
Although bariatric procedures are associated with substantial weight loss, few studies have compared surgical outcomes to nonsurgical treatment, particularly for SG.
In this retrospective, matched cohort study, adult patients with body mass index ≥35 kg/m2 who underwent RYGB or SG procedures from January 2005 through September 2015 were matched to 87,965 nonsurgical patients. Hierarchical linear models were used to investigate percent total weight loss (%TWL) and regain at 5 years among RYGB, SG, and nonsurgical patients, and at 10 years for RYGB and nonsurgical patients.
Among 13,900 SG, 17,258 RYGB, and 87,965 nonsurgical patients, the 5-year follow-up rate was 70.9%, 72.0%, and 64.5%, respectively. At 1 year, RYGB patients had 28.4%TWL (95% confidence interval: 28.2, 28.5), SG 23.0%TWL (22.8, 23.2), and nonsurgical patients 0.2%TWL (0.1, 0.4). At 5 years, RYGB had 21.7%TWL (21.5, 22.0), SG 16.0%TWL (15.4, 16.6), and nonsurgical patients 2.2%TWL (2.0, 2.5). After 5 years, 3.7% of RYGB and 10.1% of SG patients had regained weight to within 5% of baseline. At 10 years, RYGB patients had 20.2%TWL (19.3, 21.0) and nonsurgical patients 4.8%TWL (4.0, 5.5).
In this study, patients with severe obesity who underwent SG and RYGB lost significantly more weight at 5 years than nonsurgical patients. Weight regain was common after surgery but regain to within 5% of baseline was rare.
研究行袖状胃切除术（SG）、胃旁路术（RYGB）和非手术治疗的重度肥胖患者的体重变化轨迹。
尽管减重手术与显著的体重减轻相关，但很少有研究将手术结果与非手术治疗进行比较，特别是对于 SG。
在这项回顾性、匹配队列研究中，将 2005 年 1 月至 2015 年 9 月期间接受 RYGB 或 SG 手术的 BMI≥35kg/m2 的成年患者与 87965 名非手术患者相匹配。采用分层线性模型，研究 RYGB、SG 和非手术患者在 5 年时的总减重百分比（%TWL）和体重恢复情况，以及 RYGB 和非手术患者在 10 年时的%TWL。
在 13900 名 SG、17258 名 RYGB 和 87965 名非手术患者中，5 年随访率分别为 70.9%、72.0%和 64.5%。术后 1 年，RYGB 患者的体重减轻率为 28.4%（95%置信区间：28.2，28.5），SG 为 23.0%（22.8，23.2），而非手术患者为 0.2%（0.1，0.4）。术后 5 年，RYGB 患者的体重减轻率为 21.7%（21.5，22.0），SG 为 16.0%（15.4，16.6），而非手术患者为 2.2%（2.0，2.5）。术后 5 年后，3.7%的 RYGB 和 10.1%的 SG 患者体重恢复到基线的 5%以内。术后 10 年，RYGB 患者的体重减轻率为 20.2%（19.3，21.0），而非手术患者为 4.8%（4.0，5.5）。
在这项研究中，行 SG 和 RYGB 的重度肥胖患者在 5 年内体重减轻明显多于非手术患者。手术后体重恢复是常见的，但恢复到基线的 5%以内是罕见的。
