Department of Surgery, Marien Hospital Herne, Ruhr-Universität Bochum, Hölkeskampring, 40, 44625, Herne, Germany.
StatConsult Society for Clinical and Health Services Research GmbH, Am Fuchsberg 11, 39112, Magdeburg, Germany.
Obes Surg. 2021 Dec;31(12):5156-5165. doi: 10.1007/s11695-021-05706-1. Epub 2021 Sep 13.
Beginning January 1, 2005, bariatric surgery cases were examined with the help of the quality assurance study for operative medicine. All data were registered and analyzed prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg, Germany. The comparative study focuses on perioperative morbidity, complications, and remission of obesity-associated diseases after gastric bypass (RYGB) and sleeve gastrectomy (SG) at 5-year follow-up.
Data collection includes patients of full age who underwent SG or RYGB surgery between 2005 and 2017. The bougie is limited to 33-40 French for SG. The Roux-en-Y length for RYGB is set to 120-180 cm, and the biliodigestive length is set to 40-60 cm. Outcome criteria are perioperative morbidity, postoperative and intraoperative complications, and remission on comorbidities.
Between 2005 and 2017, 64,349 patients were enrolled in German Bariatric Surgery Registry (GBSR). Primary operations that were performed were 56.328. Out of 24,146 RYGB and 24,085 SG procedures, 922 patients had a complete 5-year follow-up. These are 342 SG patients and 580 patients with RYGB. A matching was realized for n = 285 (83.3%) patient pairs based on age, BMI, gender, ASA, and comorbidities. A significant disadvantage was identified for the SG procedure regarding reflux disease compared with RYGB (36.3% vs. 8.10%; p < 0.001). There were no significant disadvantages in terms of BMI reduction [14.92 in the RYGB and 14.50 in the SG (p = 0.437)] and %EWL [60.32 in the RYGB and 58.98 in the SG (p = 0.504)]. This also applies to the remission of NIDDM, IDDM, hypertension, and sleep apnea; no significant differences were found.
The results of the study show significant findings for gastroesophageal reflux. In terms of complications and obesity-associated diseases, no significant disadvantages between both treatments were found. RYGB and SG had comparable postoperative morbidity rates. The two surgical methods are legitimate bariatric procedures. However, there is a need for further evaluation to optimize patient selection in the coming years.
自 2005 年 1 月 1 日起，借助手术质量保证研究对减重手术病例进行检查。所有数据均与德国马格德堡奥托-冯-格里克大学外科质量保证研究所合作，前瞻性地进行注册和分析。该对比研究重点关注胃旁路术（RYGB）和袖状胃切除术（SG）术后 5 年随访时围手术期发病率、并发症和肥胖相关疾病缓解情况。
数据收集包括年龄在全年龄段的患者，他们在 2005 年至 2017 年间接受了 SG 或 RYGB 手术。SG 所用的探条限制为 33-40 法国号。RYGB 的 Roux 肠袢长度设定为 120-180cm，胆胰肠袢长度设定为 40-60cm。主要的转归指标包括围手术期发病率、术后和术中并发症以及合并症的缓解情况。
2005 年至 2017 年间，有 64349 名患者被纳入德国减重手术登记处（GBSR）。进行的主要手术为 56328 例。在 24146 例 RYGB 和 24085 例 SG 手术中，有 922 名患者完成了完整的 5 年随访。这些患者中有 342 例 SG 患者和 580 例 RYGB 患者。基于年龄、BMI、性别、ASA 和合并症，对 n=285（83.3%）患者对进行了匹配。RYGB 与 SG 相比，SG 手术中反流性疾病的发生率明显较高（36.3%比 8.10%；p<0.001）。RYGB 组 BMI 降低[14.92]和 SG 组 BMI 降低[14.50]（p=0.437）、%EWL 降低[60.32 和 58.98]（p=0.504）等方面均无显著差异。这也适用于 NIDDM、IDDM、高血压和睡眠呼吸暂停的缓解情况，未发现显著差异。
研究结果显示胃食管反流有显著发现。在并发症和肥胖相关疾病方面，两种治疗方法之间没有发现显著差异。RYGB 和 SG 的术后发病率相当。两种手术方法都是合法的减重手术。然而，未来几年仍需要进一步评估以优化患者选择。
