Department of Surgery, Cantonal Hospital Thurgau, Pfaffenholzstrasse 4, 8501, Frauenfeld, Switzerland.
Langenbecks Arch Surg. 2022 Dec;407(8):3341-3348. doi: 10.1007/s00423-022-02635-0. Epub 2022 Aug 10.
Surgical technique in bariatric surgery has been refined over the past decades. This study analysed the effect of changing the stapling protocol on the quality of life (QoL) at a midterm follow-up.
The retrospective cohort study included patients undergoing Roux-en-Y gastric bypass between June 2012 and March 2016. Patients were stratified into the circular stapling protocol (CSP, n = 117) or the linear stapling protocol (LSP, n = 118). QoL was quantified by the Moorehead score at 12, 24 and 60 months. Multivariate testing was used to identify confounders.
The age was 42.8 ± 11.5 years and the body mass index (BMI) was 43.8 ± 6.2 kg/m, with no baseline intergroup differences. Overall baseline Moorehead score was 0.42 ± 1.1 and improved in both groups after 12 months (1.97 ± 0.74, p < 0.001), 24 months (1.86 ± 0.79, p < 0.001) and 60 months (1.71 ± 0.9, p < 0.001). LSP was associated with improved Moorehead score after 60 months (odds ratio [OR] 1.251, 95% confidence interval [CI] 1.06-1.48, p = 0.010). Overall, a drop of mean BMI occurred and this effect lasted throughout the observation period (- 12.48 kg/m, p < 0.001). More profound BMI reduction was further positively associated with Moorehead scores after 24 and after 60 months (OR 0.97, p = 0.028; OR 0.96, p = 0.007). Complications, rehospitalisations and reoperations were more frequent in the CSP group (50% vs 23.7%, p < 0.001; 39.7% vs 22.9%, p = 0.009; 37.1% vs 18.6%, p = 0.003).
The CSP and LSP achieve a long-lasting increase in QoL, although the LSP is associated with fewer complications, persistent weight loss and improved Moorehead score. Therefore, the LSP might be considered the favourable protocol in Roux-en-Y gastric bypass.
在过去的几十年中，减重手术的外科技术得到了改进。本研究分析了在中期随访时改变吻合技术对生活质量（QoL）的影响。
这项回顾性队列研究纳入了 2012 年 6 月至 2016 年 3 月期间接受 Roux-en-Y 胃旁路术的患者。患者分为圆形吻合器吻合组（CSP，n=117）或线性吻合器吻合组（LSP，n=118）。术后 12、24 和 60 个月采用 Moorehead 评分量化 QoL。采用多变量检验来识别混杂因素。
患者年龄为 42.8±11.5 岁，体重指数（BMI）为 43.8±6.2kg/m²，组间无基线差异。总体基线 Moorehead 评分为 0.42±1.1，两组在术后 12 个月（1.97±0.74，p<0.001）、24 个月（1.86±0.79，p<0.001）和 60 个月（1.71±0.9，p<0.001）时均有所改善。LSP 与术后 60 个月时 Moorehead 评分的改善相关（比值比[OR]1.251，95%置信区间[CI]1.06-1.48，p=0.010）。总体而言，平均 BMI 下降，且该效果持续整个观察期（-12.48kg/m²，p<0.001）。BMI 下降幅度越大，术后 24 个月和 60 个月时 Moorehead 评分越高（OR 0.97，p=0.028；OR 0.96，p=0.007）。CSP 组的并发症、再住院和再次手术更为频繁（50% vs 23.7%，p<0.001；39.7% vs 22.9%，p=0.009；37.1% vs 18.6%，p=0.003）。
CSP 和 LSP 均可实现 QoL 的长期改善，尽管 LSP 与并发症更少、持续减重和 Moorehead 评分改善有关。因此，LSP 可能是 Roux-en-Y 胃旁路术的有利方案。
