Bariatric and Metabolic Surgery Unit, Discipline of Gastroenterology, Universidade de São Paulo, Sao Paulo, Brazil.
Discipline of Gastroenterology, Universidade de São Paulo, Sao Paulo, Brazil.
Obes Surg. 2021 Jun;31(6):2359-2363. doi: 10.1007/s11695-021-05316-x. Epub 2021 Mar 8.
Despite the increasing prevalence of elderly obese patients, bariatric surgery remains controversial in this population. Recent publications have focused on perioperative safety, but few studies have addressed clinical outcomes.
This study aimed to evaluate 1-year outcomes of laparoscopic sleeve gastrectomy (LSG) compared to laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients 65 years or older.
Thirty-six elderly obese patients were recruited for an open-label randomized trial from September 2017 to May 2019, comparing LSG to LRYGB. One-year outcomes were evaluated based on weight loss, functionality, and control of clinical conditions.
The median age (67 × 67 years; p=0.67) and initial body mass index (BMI) (46.3 × 51.3 kg/m; p=0.28) were similar between groups. Preoperative BMI (after weight loss pre-operative treatment) was higher in LRYGB group (41.9 × 47.6 kg/m; p= 0.03). After 12 months, EWL and TWL were higher in LRYGB group (60 × 68%; p=0.04; 24.9 × 31.4%; p<0.01). HbA1c reduction was higher after LRYGB (-1.1 × -0.5%; p<0.01) as well as LDL control (-27.5 × +11.5 mg/dL p= 0.02). No difference was noted between LRYGB and LSG concerning hypertension control, triglycerides, HDL, and functionality.
Weight loss, diabetes, and LDL control were better achieved with LRYGB after 12 months.
尽管老年肥胖患者的患病率不断增加，但肥胖症手术在该人群中仍存在争议。最近的出版物集中在围手术期安全性上，但很少有研究涉及临床结果。
本研究旨在评估腹腔镜袖状胃切除术（LSG）与腹腔镜 Roux-en-Y 胃旁路术（LRYGB）在 65 岁及以上患者中的 1 年结果。
2017 年 9 月至 2019 年 5 月，我们进行了一项开放性随机试验，招募了 36 名老年肥胖患者，比较 LSG 与 LRYGB。根据体重减轻、功能和控制临床情况评估 1 年结果。
两组的中位年龄（67×67 岁；p=0.67）和初始体重指数（BMI）（46.3×51.3 kg/m；p=0.28）相似。LRYGB 组的术前 BMI（减肥前的术前治疗后）更高（41.9×47.6 kg/m；p=0.03）。12 个月后，LRYGB 组的 EWL 和 TWL 更高（60×68%；p=0.04；24.9×31.4%；p<0.01）。LRYGB 术后的 HbA1c 降低更明显（-1.1×-0.5%；p<0.01），LDL 控制更好（-27.5×+11.5 mg/dL p=0.02）。LRYGB 和 LSG 在高血压控制、甘油三酯、HDL 和功能方面没有差异。
12 个月后，LRYGB 在体重减轻、糖尿病和 LDL 控制方面效果更好。
