Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran.
Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
Updates Surg. 2022 Aug;74(4):1399-1411. doi: 10.1007/s13304-022-01319-0. Epub 2022 Jul 2.
Bariatric surgery has been recognized as the most effective long-term treatment for morbid obesity. Despite the considerable positive results, adverse consequence can develop. Excessive Weight Loss (EXWL), a rare consequence of bariatric surgery, can lead to a broad adverse consequence. The aim of this study was determining of prevalence and the predicting model of EXWL in patient underwent bariatric surgery until 24 months after surgery. Data have been extracted from the National Obesity Surgery Database in obesity clinic of Iran University of Medical Sciences. The subjects of this retrospective cohort study were morbid obese individuals who underwent three various types of bariatric surgery [One Anastomosis Gastric Bypass (OAGB), Roux-en-Y Gastric Bypass (RYGB), or Sleeve Gastrectomy (SG)] in period of 24 months ago. EXWL has been defined as reaching to less than or equal to BMI 18.5 at any time until 24 months after surgery. SPSS was used in data analysis. Among 4214 subjects of this study, most excess weight loss after surgery has taken place in 18 months after surgery. 11.4% (n = 495) of patients experienced EXWL with highest percentage among OAGB patients (15.1%) at time of 24 months after surgery. The females (20.4% vs.9.9%) and younger persons (35.45 ± 10.25 vs. 39.06 ± 10.76) were more susceptible to EXWL. Patients with EXWL had significantly lower BMI (body mass index) (41.11 ± 4.51 vs. 46.73 ± 6.26) (Kg/m), and were less probable to had emotional eating. Visceral fat level, fat percentage, and BMI were the best predictor of EXWL (P value for all < 0.05). So that per level increase in visceral fat, decreases the probability of EXWL as 47% and 61% in SG and OAGB. Moreover, each unit lower BMI leads to 25% higher susceptibility to experience EXWL. Surgery should be adjusted in younger females with a lower BMI and healthy metabolic status who are more prone to EXWL. In such a way that minimize weight loss speed/value. It may be possible by selection of other surgery procedures, rather than OAGB, tighter follow-ups, and consultations of patients after surgery is emphasized for more EXWL vulnerable patients.
减重手术已被公认为治疗病态肥胖症最有效的长期治疗方法。尽管取得了相当大的积极成果，但仍可能出现不良后果。体重过度减轻（EXWL）是减重手术的罕见后果，可导致广泛的不良后果。本研究的目的是确定接受减重手术的患者在术后 24 个月内 EXWL 的患病率和预测模型。数据从伊朗医科大学肥胖诊所的国家肥胖手术数据库中提取。这项回顾性队列研究的对象是在 24 个月前接受过三种不同类型减重手术的病态肥胖个体[单吻合胃旁路术（OAGB）、Roux-en-Y 胃旁路术（RYGB）或袖状胃切除术（SG）]。EXWL 定义为在术后任何时间达到 BMI 等于或小于 18.5。数据分析采用 SPSS。在这项研究的 4214 名受试者中，大多数术后体重减轻发生在术后 18 个月。术后 24 个月时，11.4%（n=495）的患者出现 EXWL，OAGB 患者的百分比最高（15.1%）。女性（20.4%对 9.9%）和年轻人（35.45±10.25 对 39.06±10.76）更容易出现 EXWL。EXWL 患者的 BMI（体重指数）明显较低（41.11±4.51 对 46.73±6.26）（Kg/m），并且不太可能出现情绪性进食。内脏脂肪水平、脂肪百分比和 BMI 是 EXWL 的最佳预测指标（所有 P 值均<0.05）。因此，在 SG 和 OAGB 中，内脏脂肪每增加一个水平，EXWL 的可能性就会降低 47%和 61%。此外，BMI 每降低一个单位，EXWL 的易感性就会增加 25%。对于更容易出现 EXWL 的年轻女性、BMI 较低且代谢状况健康的患者，应调整手术。以这种方式，尽量降低减重速度/值。这可能通过选择其他手术程序来实现，而不是 OAGB，更严格的随访，以及强调术后对更易出现 EXWL 脆弱的患者进行咨询。
