单吻合口胃旁路术与 Roux-en-Y 胃旁路术治疗限制型减重手术后减重不足和体重反弹
One anastomosis gastric bypass vs. Roux-en-Y gastric bypass, remedy for insufficient weight loss and weight regain after failed restrictive bariatric surgery.
机构信息
Department of Surgery, Franciscus Gasthuis & Vlietland, Locatie Gasthuis, Afdeling Heelkunde, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
Department of Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
出版信息
Obes Surg. 2020 Sep;30(9):3287-3294. doi: 10.1007/s11695-020-04536-x.
BACKGROUND
Failure occurs in up to 60% of the patients that were treated with primary restrictive bariatric operations such as Laparoscopic Adjustable Gastric Banding (LAGB), or restrictive/metabolic operations like Laparoscopic Sleeve Gastrectomy (LSG). Insufficient weight loss and weight regain are the most commonly reported reasons of failure. The aim of this retrospective multicenter study was to compare One Anastomosis Gastric Bypass (OAGB) to Roux-en-Y Gastric Bypass (RYGB) as a revisional procedure in terms of weight loss, procedure time, complication rate and morbidity.
METHODS
491 patients operated on between 2012 and 2017 for failed restrictive surgery were included in this study (OAGB (n=185) or RYGB (n=306)). Failure was defined as total weight loss (TWL) less than 25%, excess weight loss (EWL) less than 50% and/or a remaining body mass index (BMI) larger than 40 kg/m2 at two years of follow up. Primary outcome measures were %TWL and % excess BMI loss (EBMIL) at 12, 24 and 36 months of follow-up. Secondary outcomes were procedure time, reduction of comorbidity, early and late complication rate, and mortality.
RESULTS
%TWL was significantly larger in the OAGB group at 12 months (mean 24.1±9.8 vs. 21.9±9.7, p = 0.023) and 24 months (mean 23.9±11.7 vs. 20.5±11.2, p = 0.023) of follow-up. %EBMIL was significantly larger in the OAGB group at 12 months (mean 69.0±44.6 vs. 60.0±30.1, p = 0.014) and 24 months (mean 68.6±51.6 vs. 56.4±35.4, p = 0.025) of follow-up. Intra-abdominal complications (leakage, bleeding, intra-abdominal abscess and perforation) occurred less frequently after revisional OAGB (1.1% vs. 4.9%, p = 0.025). Surgical intervention for biliary reflux (5.4% vs. 0.3%, p < 0.001) was more prevalent in the OAGB group. Surgical intervention for internal herniation (0.0% vs. 4.9%, p = 0.002) was more prevalent in the RYGB group.
CONCLUSIONS
This study suggests that OAGB is superior to RYGB as a remedy for insufficient weight loss and weight regain after failed restrictive surgery with more weight loss and a lower early complication rate. To substantiate these findings, further research from prospective randomized controlled trials is needed.
背景
接受原发性限制型减重手术（如腹腔镜可调节胃束带术（LAGB））或限制/代谢手术（如腹腔镜袖状胃切除术（LSG））治疗的患者中，多达 60%的患者会出现手术失败。体重减轻不足和体重反弹是最常见的失败原因。本回顾性多中心研究的目的是比较单吻合口胃旁路术（OAGB）和 Roux-en-Y 胃旁路术（RYGB）作为修正手术在减重、手术时间、并发症发生率和发病率方面的效果。
方法
本研究纳入了 2012 年至 2017 年间因限制性手术失败而接受手术的 491 例患者（OAGB（n=185）或 RYGB（n=306））。手术失败定义为总体重减轻（TWL）<25%、多余体重减轻（EWL）<50%和/或在两年随访时 BMI 仍大于 40kg/m2。主要结局测量指标为 12、24 和 36 个月随访时的%TWL 和%多余 BMI 损失（EBMIL）。次要结局测量指标为手术时间、合并症的减少、早期和晚期并发症发生率以及死亡率。
结果
OAGB 组在 12 个月（平均 24.1±9.8%比 21.9±9.7%，p=0.023）和 24 个月（平均 23.9±11.7%比 20.5±11.2%，p=0.023）的随访时%TWL 明显更大。OAGB 组在 12 个月（平均 69.0±44.6%比 60.0±30.1%，p=0.014）和 24 个月（平均 68.6±51.6%比 56.4±35.4%，p=0.025）的随访时%EBMIL 明显更大。OAGB 组术后腹腔内并发症（渗漏、出血、腹腔脓肿和穿孔）发生率较低（1.1%比 4.9%，p=0.025）。OAGB 组发生胆道反流的手术干预（5.4%比 0.3%，p<0.001）更为常见。OAGB 组发生内疝的手术干预（0.0%比 4.9%，p=0.002）更为常见。
结论
本研究表明，OAGB 作为限制型减重手术后体重减轻不足和体重反弹的补救措施优于 RYGB，因为 OAGB 可获得更多的体重减轻，且早期并发症发生率更低。为了证实这些发现，需要进一步开展前瞻性随机对照试验的研究。
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