Andersen T, Backer O G, Astrup A, Quaade F
Department of Internal Medicine, Hvidovre Hospital, Denmark.
Int J Obes. 1987;11(3):295-304.
Horizontal and vertical banded gastroplasty (GP) were compared as to their effectiveness and side-effects in patients pre-treated for morbid obesity with a very-low-calorie formula diet (VLCD). The pre-treatment served to select the compliant patients, to minimize the surgical hazard, and to optimize the total weight reduction. Seventy-four consecutive patients (median age 34 years, median body weight 125.1 kg, and median overweight 93 per cent) were included according to the criteria for entry. The median weight loss on VLCD was 25.7 kg (range, 5.8-92.6 kg) and the median overweight reduction reached 46 per cent of the initial overweight (range, 9-83 per cent). Only few and mild side-effects were observed. Sixty-nine per cent of the patients fulfilled our criterion for surgery by reducing their initial overweight by at least 40 per cent. Of these, 23 and 22 patients were assigned respectively to either vertical banded or to horizontal GP. Patients and dietitians were not informed of the assignment. A significant weight loss occurred in both groups. Three months after surgery weight loss after vertical banded GP proved to be the larger (P less than 0.001). The difference became even more pronounced due to an earlier regain among patients treated with the horizontal GP. Thus, at 12 months, the net weight loss after surgery was 9.7 kg (range, -28.2-28.7 kg) in the vertical banded GP group and -1.0 kg (range, -15.0-36.5 kg) in patients treated with horizontal GP (P less than 0.0005). At this time, the total weight loss in the groups was 48.5 kg (range, 6.4-104.0 kg) and 32.6 (range, 3.7-125.1 kg) respectively (P less than 0.02), and the total reduction of overweight was greater in the group treated with vertical banded GP (80 per cent (range, 10-96) versus 56 per cent (range, 8-92), P less than 0.005). There were no deaths, and side-effects to VLCD as well as to GP were generally mild. It is concluded that vertical banded GP is more effective than horizontal GP and that the former operation adds a significant weight loss to that obtained by VLCD. The combined treatments offer a weight reduction comparable to that observed after jejunoileal bypass. However, some regain within 1 year makes it questionable if the vertical banded GP is sufficient to prevent weight regain.
对接受极低热量配方饮食（VLCD）预处理的病态肥胖患者，比较了水平和垂直束带胃成形术（GP）的有效性和副作用。预处理旨在挑选依从性好的患者，将手术风险降至最低，并优化总体减重效果。根据入选标准，纳入了74例连续患者（中位年龄34岁，中位体重125.1kg，中位超重93%）。VLCD治疗期间的中位体重减轻为25.7kg（范围5.8 - 92.6kg），超重减轻的中位数达到初始超重的46%（范围9 - 83%）。仅观察到少数轻微副作用。69%的患者通过将初始超重减轻至少40%达到了我们的手术标准。其中，23例和22例患者分别被分配接受垂直束带或水平GP手术。患者和营养师均未被告知分组情况。两组均出现显著体重减轻。垂直束带GP术后3个月的体重减轻更为明显（P < 0.001）。由于水平GP治疗的患者体重恢复较早，这种差异变得更加显著。因此，在12个月时，垂直束带GP组术后净体重减轻为9.7kg（范围 - 28.2 - 28.7kg），水平GP治疗的患者为 - 1.0kg（范围 - 15.0 - 36.5kg）（P < 0.0005）。此时，两组的总体重减轻分别为48.5kg（范围6.4 - 104.0kg）和32.6kg（范围3.7 - 125.1kg）（P < 0.02），垂直束带GP治疗组的超重总体减轻幅度更大（80%（范围10 - 96）对56%（范围8 - 92），P < 0.005）。无死亡病例，VLCD及GP的副作用一般较轻。结论是垂直束带GP比水平GP更有效，且前者手术在VLCD减重基础上增加了显著的体重减轻。联合治疗的减重效果与空肠回肠旁路术后相当。然而，1年内出现的一些体重反弹使得垂直束带GP是否足以防止体重反弹存在疑问。
