Khalaj Alireza, Tasdighi Erfan, Hosseinpanah Farhad, Mahdavi Maryam, Valizadeh Majid, Farahmand Elham, Taheri Hamidreza, Barzin Maryam
Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran.
Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Surg. 2020 Jul 20;20(1):160. doi: 10.1186/s12893-020-00819-3.
Bariatric surgery is an effective treatment for obesity and its associated comorbidities. This is the first comprehensive report of a prospective cohort study, comparing sleeve gastrectomy (SG) with gastric bypass (GB) regarding their effectiveness and safety.
The prospectively collected data of patients, who presented to a specialized bariatric center and underwent a primary bariatric procedure, were compared in terms of weight loss, remission of obesity-associated comorbidities, complication rate, and quality of life improvement at 6-, 12-, and 24-month follow-ups.
Of 3287 patients (78.6% female) analyzed, 67% (n = 2202) and 33% (n = 1085) underwent SG and GB, respectively. Effective outcomes were reported in both groups regarding the body composition indices. Type 2 diabetes mellitus (T2DM) remission rate at the end of follow-up was 53.3% and 63.8% in the SG and GB groups, respectively. Following the propensity score-adjusted analysis, the T2DM remission rate was not significantly different between the groups. Conversely, the remission rate of hypertension in the 24-month follow-up (39.1% vs. 54.7%) and the remission rate of dyslipidemia in all follow-ups were lower in the SG group, compared to the GB group. Moreover, both procedures caused substantial improvements in various domains of quality of life. The surgery duration, early complication rate, and nutritional deficiencies were lower in the SG group, compared to the GB group.
Both surgical procedures were effective in the control of obesity and remission of its comorbidities. However, since SG was associated with a lower rate of complications, it seems that SG should be considered as a suitable procedure for obese patients, especially those with a healthier metabolic profile.
减重手术是治疗肥胖及其相关合并症的有效方法。这是一项前瞻性队列研究的首次综合报告，比较了袖状胃切除术（SG）和胃旁路术（GB）的有效性和安全性。
对前瞻性收集的、前往专门的减重中心并接受初次减重手术的患者数据，在6个月、12个月和24个月随访时，就体重减轻、肥胖相关合并症的缓解情况、并发症发生率和生活质量改善情况进行比较。
在分析的3287例患者中（78.6%为女性），分别有67%（n = 2202）和33%（n = 1085）接受了SG和GB手术。两组在身体成分指标方面均报告了有效结果。随访结束时，SG组和GB组的2型糖尿病（T2DM）缓解率分别为53.3%和63.8%。经过倾向评分调整分析后，两组之间的T2DM缓解率无显著差异。相反，与GB组相比，SG组在24个月随访时的高血压缓解率（39.1%对54.7%）以及所有随访中的血脂异常缓解率较低。此外，两种手术均使生活质量的各个领域有显著改善。与GB组相比，SG组的手术时间、早期并发症发生率和营养缺乏情况较低。
两种手术在控制肥胖及其合并症的缓解方面均有效。然而，由于SG的并发症发生率较低，似乎SG应被视为肥胖患者，尤其是代谢状况较健康患者的合适手术方式。
