Obesity Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy.
Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy.
Eat Weight Disord. 2021 Aug;26(6):1871-1880. doi: 10.1007/s40519-020-01030-2. Epub 2020 Oct 12.
The Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is an effective weight loss procedure. The gastro-jejunal (GJ) anastomosis required can be performed on the anterior or posterior gastric pouch wall. No studies have compared these variants in terms of efficacy and onset of dumping syndrome (DS) and weight regain (WR). We aimed at assessing the prevalence of DS in relation to the site of anastomosis together with identifying prognostic factors of DS and WR.
Patients who had undergone LRYGB with anterior (AGJ) or posterior (PGJ) anastomosis in 2010-2019 were retrospectively analyzed. We collected demographic data, medical history and the prevalence of DS evaluated through the Sigstad Score, together with WR data.
213 patients were enrolled, of which 51.6% had an AGJ and 48.4% had a PGJ. The mean follow-up time was 81 ± 18 and 27 ± 13 months in the AGJ and PGJ group, respectively (p < 0.0001). Excess weight loss was 77.59% and 94.13% in patients with AGJ and PGJ, respectively (p < 0.001). WR rate was 16% and 4% in the AGJ and PGJ population, respectively (p < 0.001). DS prevalence was 38% and 76% in the AGJ and the PGJ population, respectively (p < 0.0001). The site of anastomosis was identified as an independent predictor of DS (OR5.15; 95% CI 2.82-9.41; p < 0.0001) and WR (OR5.31; 95% CI 2.32-12.15; p < 0.0001). Obesity-related complications significantly improved after surgery independent of the anastomosis site.
LRYGB is effective in determining long-term weight loss and improvement of complications. AGJ is associated with lower prevalence of DS but more frequent WR. The anastomosis site is a factor to be considered when performing LRYGB.
Level V, cross-sectional descriptive study.
腹腔镜 Roux-en-Y 胃旁路术（LRYGB）是一种有效的减肥手术。需要的胃空肠（GJ）吻合术可以在前胃囊壁或后胃囊壁上进行。目前还没有研究比较这两种吻合术在倾倒综合征（DS）和体重复发性（WR）方面的效果。我们旨在评估吻合部位与 DS 发病之间的相关性，并确定 DS 和 WR 的预测因素。
回顾性分析 2010 年至 2019 年间行 LRYGB 术的患者，吻合部位为前壁（AGJ）或后壁（PGJ）。收集患者的人口统计学资料、病史和 DS 发生率（Sigstad 评分），并记录 WR 数据。
共纳入 213 例患者，其中 51.6%为 AGJ，48.4%为 PGJ。AGJ 组和 PGJ 组的平均随访时间分别为 81±18 个月和 27±13 个月（p<0.0001）。AGJ 组和 PGJ 组患者的 excess weight loss 分别为 77.59%和 94.13%（p<0.001）。AGJ 组和 PGJ 组 WR 发生率分别为 16%和 4%（p<0.001）。AGJ 组和 PGJ 组 DS 发生率分别为 38%和 76%（p<0.0001）。吻合部位是 DS（OR5.15；95%CI 2.82-9.41；p<0.0001）和 WR（OR5.31；95%CI 2.32-12.15；p<0.0001）的独立预测因子。
LRYGB 术能有效确定长期减重效果，并改善肥胖相关并发症。AGJ 与 DS 发生率较低相关，但 WR 发生率较高。吻合部位是行 LRYGB 术时需考虑的因素。
五级，横断面描述性研究。
