Department of Upper Gastrointestinal and Bariatric Surgery, Musgrove Park Hospital, Taunton, TA1 5DA, UK.
Obes Surg. 2021 Jun;31(6):2444-2452. doi: 10.1007/s11695-021-05331-y. Epub 2021 Mar 25.
Decreasing popularity of Roux-en-Y gastric bypass (RYGB) in bariatric-metabolic surgery may be due to higher perceived peri-operative complications. There are few studies on whether preoperative weight loss can reduce complications or reoperations following RYGB. We investigated this using a standardised operative technique.
Retrospective single-centre study of RYGB from 2004 to 2019 using a prospective database. Preoperative behavioural management included intentional weight loss. Maximum preoperative weight, weight on the day of operation, and Obesity-Surgery Mortality Risk Score (OS-MRS) class were recorded. Short-term outcomes (post-operative stay, 30-day complication and reoperation rates) were analysed.
In 2,067 RYGB patients (1,901 primary and 166 revisional), median preoperative total body weight loss (TWL) was 6.2% (IQR: 2.5-10.7%). The median age was 46 (interquartile range (IQR) 38-54) and 80.4% were female (n=1,661). For primary surgery, the median body mass index (BMI) was 47.6 kg/m (IQR: 43.1-53.3). Excluding the 100-procedure learning curve, the complication rate for primary cases was 4.4% and reoperation rate of 2.8% and one peri-operative mortality (0.06%). OS-MRS ≥2 (class B or C) predicted higher risk of complications (6.1%) compared to those with a score <2 (class A) (3.8%, p=0.021), but not reoperations. Five percent preoperative TWL did not decrease complications compared to <5% TWL. Patients with ≥10% TWL had greater baseline risk and had an increased risk of complications (6.6% vs 3.7%, p=0.017) and reoperations (4.5% vs 2.7%, p<0.001).
RYGB performed using a standardised technique has low overall risk. The influence of preoperative weight loss on outcomes was inconsistent.
减重代谢手术中 Roux-en-Y 胃旁路术（RYGB）的普及度降低可能是由于人们认为其围手术期并发症更高。关于术前体重减轻是否可以降低 RYGB 后的并发症或再次手术，研究甚少。我们使用标准化手术技术对此进行了研究。
这是一项回顾性单中心研究，对 2004 年至 2019 年期间使用前瞻性数据库进行的 RYGB 进行研究。术前行为管理包括有意的体重减轻。记录最大术前体重、手术当天体重和肥胖手术死亡率风险评分（OS-MRS）类别。分析短期结果（术后住院时间、30 天并发症和再次手术率）。
在 2067 例 RYGB 患者（1901 例原发性和 166 例修正性）中，中位术前总体体重减轻（TWL）为 6.2%（IQR：2.5-10.7%）。中位年龄为 46 岁（四分位距（IQR）38-54 岁），80.4%为女性（n=1661）。对于原发性手术，中位体重指数（BMI）为 47.6kg/m2（IQR：43.1-53.3）。排除 100 例手术学习曲线后，原发性病例的并发症发生率为 4.4%，再次手术率为 2.8%，1 例围手术期死亡率（0.06%）。OS-MRS≥2（B 类或 C 类）预测并发症风险较高（6.1%），与评分<2（A 类）（3.8%，p=0.021）相比，但不包括再次手术。与 TWL<5%相比，TWL≥5% 并未降低并发症发生率。TWL≥10%的患者基线风险更高，且并发症（6.6%比 3.7%，p=0.017）和再次手术（4.5%比 2.7%，p<0.001）的风险增加。
使用标准化技术进行的 RYGB 整体风险较低。术前体重减轻对结果的影响不一致。
