Department of General Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Obes Surg. 2022 Jul;32(7):2309-2320. doi: 10.1007/s11695-022-06078-w. Epub 2022 Apr 29.
There is a controversy on the suitable bariatric procedure for patients with BMI > 50 kg/m. Many surgeons prefer the Roux en-Y gastric bypass (RYGB) while others resort to long biliopancreatic limb (BPL) one anastomosis gastric bypass (OAGB).
This study included patients with BMI > 50 kg/m who underwent 250-cm BPL OAGB with total bowel length (TBL) > 6 m and completed 24-month follow-up from July 2015 to November 2021. Demographic data with preoperative weight, BMI, hypertension (HTN), DM (HbA1C), Hb, iron, calcium, albumin, vitamin D, and parathormone levels (PTH) were recorded. Operative time, total bowel length (TBL), residual length (RBL), complications and postoperative weight, BMI, % of total weight loss (%TWL), HTN, DM, and alkaline reflux as well as Hb, iron, calcium, albumin, vitamin D, and PTH levels were recorded at 6, 12, 18, and 24 months.
OAGB had a significant decrease in weight, BMI (25.6 ± 3.4 kg/m at 24 months) with %TWL of 48 ± 5% at 24 months. TBL and RBL were 6.7 ± 0.65 and 4.2 ± 0.65 m respectively. %BL (RBL/TBL*100) was 62.4 ± 3.3%. The HbA1C, HTN, and alkaline reflux incidence were 5.5 ± 0.29 gm%, 1.4%, and 3.7% respectively at 24 months. Hb, iron, calcium, albumin, and vitamin D showed a significant decrease but still within normal range, and PTH showed a significant increase at 24 months.
Long BP (250 cm) OAGB in patients with BMI > 50 kg/m with TWL > 6 m had good results in the achievement of weight loss and weight maintenance goals with remission of associated comorbidities as HTN and DM.
对于 BMI>50kg/m2 的患者，哪种减重手术更合适存在争议。许多外科医生倾向于 Roux-en-Y 胃旁路术（RYGB），而另一些医生则选择长胆胰支（BPL）一吻合胃旁路术（OAGB）。
本研究纳入了 2015 年 7 月至 2021 年 11 月间接受 250cm 长 BPL OAGB 手术且总肠长度（TBL）>6m 并完成 24 个月随访的 BMI>50kg/m2 患者。记录人口统计学数据，包括术前体重、BMI、高血压（HTN）、糖尿病（HbA1C）、血红蛋白（Hb）、铁、钙、白蛋白、维生素 D 和甲状旁腺激素（PTH）水平。记录手术时间、总肠长度（TBL）、残肠长度（RBL）、并发症以及术后体重、BMI、体重减轻百分比（%TWL）、HTN、糖尿病和碱性反流以及 Hb、铁、钙、白蛋白、维生素 D 和 PTH 水平，随访时间点为术后 6、12、18 和 24 个月。
OAGB 显著降低了体重和 BMI（24 个月时为 25.6±3.4kg/m2），24 个月时的体重减轻百分比（%TWL）为 48±5%。TBL 和 RBL 分别为 6.7±0.65m 和 4.2±0.65m。%BL（RBL/TBL*100）为 62.4±3.3%。24 个月时，HbA1C、HTN 和碱性反流发生率分别为 5.5±0.29g%、1.4%和 3.7%。Hb、铁、钙、白蛋白和维生素 D 显著下降，但仍在正常范围内，PTH 显著升高。
在 BMI>50kg/m2 且 TWL>6m 的患者中，行长 BPL（250cm）OAGB 可达到减重和维持体重的目标，同时缓解高血压和糖尿病等合并症。
