Pizza Francesco, Lucido Francesco Saverio, D'Antonio Dario, Tolone Salvatore, Gambardella Claudio, Dell'Isola Chiara, Docimo Ludovico, Marvaso Alberto
Division of Surgery, Hospital "A. Rizzoli", Lacco Ameno, Naples, Italy.
Division of General, Mininvasive and Bariatric Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
Obes Surg. 2020 Oct;30(10):3685-3694. doi: 10.1007/s11695-020-04687-x.
The use of one anastomosis gastric bypass (OAGB) is rapidly spreading. Concerns about biliary reflux and malabsorption with consequent nutritional deficits exist, so studies on biliopancreatic limb (BPL) adequate length in OAGB are required to balance excess weight loss in percentage (% EWL), resolution of comorbidities, and nutritional deficit. The purpose was to evaluate, at 2 years after OAGB, the effects of BPL length on weight loss, resolution of comorbidity, and nutritional deficiencies in patients.
From January 2015 to January 2017, 180 patients were collected into three groups based BPL length: group A, 150 cm; group B, 180 cm; and group C, 200 cm. Aims were to compare %EWL, co-morbidity resolution rates, nutritional parameters, and morbidity/mortality in the three groups.
The total number of patients was 180: 60 for each group. One hundred seventy-two (95%) patients attended the 1-year follow-up (group A = 58; group B = 58, group C = 56). One hundred fifty-seven (87%) patients attended the 2-year follow-up (group A = 52 (87%); group B = 53 (88%); group C = 52 (87%)). There was no statistically significant difference in %EWL, %TWL, T2DM, and hypertension resolution rates among the groups. About vitamin deficiency, differences were not statistically significant. Iron and ferritin deficiency rate were statistically significant only between A and C groups.
According to our evidence, standardization of BPL length shorter than 200 cm is suggested, potentially minimizing malnutrition-related outcomes. Our study seems to show that a BPL of 150-180 cm is safe and effective in terms of EWL and comorbidity improvement with low malnutrition effects even in BMI > 50.
单吻合口胃旁路术（OAGB）的应用正在迅速普及。人们担心胆汁反流和吸收不良会导致营养缺乏，因此需要对OAGB中胆胰支（BPL）的合适长度进行研究，以平衡体重减轻百分比（%EWL）、合并症的解决和营养缺乏之间的关系。目的是评估OAGB术后2年时，BPL长度对患者体重减轻、合并症解决和营养缺乏的影响。
2015年1月至2017年1月，根据BPL长度将180例患者分为三组：A组，150cm；B组，180cm；C组，200cm。目的是比较三组的%EWL、合并症解决率、营养参数以及发病率/死亡率。
患者总数为180例，每组60例。172例（95%）患者参加了1年随访（A组=58例；B组=58例，C组=56例）。157例（87%）患者参加了2年随访（A组=52例（87%）；B组=53例（88%）；C组=52例（87%））。各组之间的%EWL、%TWL、2型糖尿病和高血压解决率无统计学显著差异。关于维生素缺乏，差异无统计学意义。铁和铁蛋白缺乏率仅在A组和C组之间有统计学显著差异。
根据我们的证据，建议将BPL长度标准化为短于200cm，这可能会将与营养不良相关的结果降至最低。我们的研究似乎表明，150 - 180cm的BPL在EWL和合并症改善方面是安全有效的，即使在BMI > 50时营养不良影响也较低。
