Department of Weight Loss and Health Management Center, E-DA Dachang Hospital, Kaohsiung, Taiwan.
Department of Asia Obesity Medical Research Center, E-DA Hospital, Kaohsiung, Taiwan.
Obes Surg. 2021 Aug;31(8):3391-3399. doi: 10.1007/s11695-021-05464-0. Epub 2021 May 16.
The most appropriate procedure for the treatment of super obesity (BMI > 50 kg/m) is unknown. We aimed to evaluate the safety, long-term (> 5 years) weight loss, and adverse events between three commonly performed procedures, sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) in super-obese patients.
Between January 2002 and December 2015, 498 successive patients with super morbid obesity (BMI > 50), who underwent SG or RYGB or OAGB, were recruited. Surgical outcome, weight loss, resolution of co-morbidities, and late complications were followed and compared between the 3 groups. All data derived from a prospective bariatric database and a retrospective analysis was conducted.
The average patient age was 32.1 ± 10.4 years, with a mean body mass index (BMI) of 56.0 ± 6.7 kg/m. Of them, 190 (38.9%) underwent SG, 62 (12.4%) RYGB, and 246 (49.4%) OAGB. There was no difference in basic characters between the 3 groups except SG had fewer diabetic patients. RYGB group had higher intraoperative blood loss, longer operating time, and hospital stay than the other 2 groups. RYGB had a higher 30-days post-operative major complication rate (4.8%) than SG (0.5%) and OAGB (0.8%). The follow-up rate at 1 and 5 years was 89.4% and 52.0%. At post-operative 5 years, OAGB had a higher total weight loss (40.8%) than SG (35.1%), but not RYGB (37.2%). SG had a lower remission rate in dyslipidemia comparing to OAGB and RYGB, but T2DM remission rate was no different between the groups. The overall revision rate is 5.4% (27/498) of the whole group, and SG had a lower revision rate (2.6%) than RYGB (8.1%) and OAGB (6.9%).
SG is an effective and durable primary bariatric procedure for the treatment of super obesity and metabolic disorders. OAGB had a similar operation risk to SG but resulted in a better weight loss than SG.
治疗超级肥胖（BMI＞50kg/m²）的最佳方法尚不清楚。我们旨在评估袖状胃切除术（SG）、胃旁路术（RYGB）和单吻合口胃旁路术（OAGB）三种常见手术在超级肥胖患者中的安全性、长期（＞5 年）减重效果和不良事件。
2002 年 1 月至 2015 年 12 月，我们连续招募了 498 例超级病态肥胖（BMI＞50）患者，他们接受了 SG 或 RYGB 或 OAGB 治疗。比较了三组患者的手术结果、体重减轻、合并症的缓解情况和晚期并发症。所有数据均来自前瞻性减重数据库和回顾性分析。
患者平均年龄为 32.1±10.4 岁，平均 BMI 为 56.0±6.7kg/m²。其中 190 例（38.9%）接受 SG 治疗，62 例（12.4%）接受 RYGB 治疗，246 例（49.4%）接受 OAGB 治疗。三组患者的基本特征无差异，除 SG 组糖尿病患者较少外。RYGB 组术中出血量、手术时间和住院时间均高于其他两组。RYGB 术后 30 天的主要并发症发生率（4.8%）高于 SG（0.5%）和 OAGB（0.8%）。术后 1 年和 5 年的随访率分别为 89.4%和 52.0%。术后 5 年，OAGB 的总减重率（40.8%）高于 SG（35.1%），但与 RYGB（37.2%）无差异。SG 在血脂异常方面的缓解率低于 OAGB 和 RYGB，但三组间 T2DM 缓解率无差异。全组总的修正率为 5.4%（27/498），SG 的修正率（2.6%）低于 RYGB（8.1%）和 OAGB（6.9%）。
SG 是治疗超级肥胖和代谢紊乱的有效且持久的主要减重手术。OAGB 的手术风险与 SG 相似，但减重效果优于 SG。
