Department of Surgery, Voss Hospital, Haukeland University Hospital, Voss, Norway.
Department of Medicine, Haugesund Hospital, Haugesund, Norway.
Int J Obes (Lond). 2022 Apr;46(4):739-749. doi: 10.1038/s41366-021-01028-5. Epub 2022 Jan 1.
BACKGROUND/OBJECTIVES: There is limited long-term data comparing the outcomes of sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) for severe obesity, both with respect to body weight, quality of life (QOL) and comorbidities. We aimed to determine 7-year trajectories of body mass index (BMI), QOL, obesity-related comorbidities, biomarkers of glucose and lipid metabolism, and early major complications after SG and RYGB.
SUBJECTS/METHODS: Patients scheduled for bariatric surgery at two Norwegian hospitals, preferentially performing either SG or RYGB, were included consecutively from September 2011 to February 2015. Data was collected prospectively before and up to 7 years after surgery. Obesity-specific, generic and overall QOL were measured by the Impact of Weight on Quality of Life-Lite, Short-Form 36 and Cantril's ladder, respectively. Comorbidities were assessed by clinical examination, registration of medication and analysis of glucose and lipid biomarkers. Outcomes were examined with linear mixed effect models and relative risk estimates.
Of 580 included patients, 543 (75% women, mean age 42.3 years, mean baseline BMI 43.0 kg/m) were operated (376 SG and 167 RYGB). With 84.2% of participants evaluable after 5-7 years, model-based percent total weight-loss (%TWL) at 7 years was 23.4 after SG versus 27.3 after RYGB (difference 3.9%, p = 0.001). All levels of QOL improved similarly after the two surgical procedures but remained below reference data from the general population at all timepoints. Remission rates for type 2 diabetes, dyslipidemia, obstructive sleep-apnea and gastroesophageal reflux disease (GERD) as well as the rate of de novo GERD significantly favored RYGB. SG had fewer major early complications, but more minor and major late complications combined over follow-up.
In routine health care, both SG and RYGB are safe procedures with significant long-term weight-loss, improvement of QOL and amelioration of comorbidities. Long-term weight-loss and remission rates of main obesity-related comorbidities were higher after RYGB.
背景/目的： sleeve gastrectomy (SG) 和 Roux-en-Y gastric bypass (RYGB) 治疗严重肥胖症的长期结局数据有限，在体重、生活质量 (QOL) 和合并症方面均如此。我们旨在确定 SG 和 RYGB 术后 7 年的体重指数 (BMI)、QOL、肥胖相关合并症、血糖和脂质代谢生物标志物以及早期主要并发症的变化轨迹。
对象/方法： 2011 年 9 月至 2015 年 2 月，连续纳入在挪威两家医院接受减重手术的患者，医院优先进行 SG 或 RYGB。在手术前和手术后 7 年内前瞻性收集数据。使用体重对生活质量的影响简表、健康调查简表 36 版和坎特利尔梯级量表分别测量肥胖特异性、一般和总体 QOL。通过临床检查、药物登记以及血糖和脂质生物标志物分析评估合并症。使用线性混合效应模型和相对风险估计来检查结局。
580 例纳入患者中，543 例（75%为女性，平均年龄 42.3 岁，平均基线 BMI 43.0kg/m2）接受了手术（376 例行 SG，167 例行 RYGB）。5-7 年后 84.2%的参与者可评估，SG 组 7 年时的体重总减轻百分比（%TWL）为 23.4%，而 RYGB 组为 27.3%（差异 3.9%，p=0.001）。两种手术治疗后 QOL 均以相似的速度改善，但在所有时间点仍低于一般人群的参考数据。2 型糖尿病、血脂异常、阻塞性睡眠呼吸暂停和胃食管反流病 (GERD) 的缓解率以及新发 GERD 率均显著有利于 RYGB。SG 的早期主要并发症较少，但在随访期间的轻微和主要晚期并发症较多。
在常规医疗保健中，SG 和 RYGB 都是安全的手术，具有显著的长期减重效果、生活质量改善和合并症缓解作用。RYGB 后长期体重减轻和主要肥胖相关合并症的缓解率更高。
