Department of Visceral Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Faculty of Biology and Medicine, University of Lausanne (UNIL), Lausanne, Switzerland.
BJS Open. 2022 Nov 2;6(6). doi: 10.1093/bjsopen/zrac145.
Although Roux-en-Y gastric bypass (RYGB) is widely performed worldwide, its efficacy in patients with a body mass index (BMI) greater than 50 kg/m2 remains controversial. The aim of the present paper was to assess long-term (10 years or more) weight loss and metabolic results of RYGB in patients with superobesity (SO; BMI > 50 kg/m2), compared with patients with morbid obesity (MO; BMI 35-50 kg/m2).
This study involved retrospective analysis of a prospectively followed cohort of adult patients operated on for a primary RYGB between 1999 and 2008. Long-term weight loss and metabolic parameters were compared between SO and MO patients, with a sex-specific subgroup analysis in SO patients. Multiple logistic regression assessed independent predictors of poor long-term weight loss.
Among the 957 included patients, 193 (20.2 per cent) were SO (mean BMI 55.3 kg/m2versus 43.3 kg/m2 in MO). Upon 10-year follow-up, which was complete in 86.3 per cent of patients, BMI remained higher in SO patients (mean 39.1 kg/m2versus 30.8 kg/m2, P < 0.001) although total bodyweight loss (per cent TBWL) was similar (28.3 per cent versus 28.8 per cent, P = 0.644). Male SO patients had a trend to higher 10-year per cent TBWL, while initial BMI greater than 50 kg/m2 and low 5-year per cent TBWL were independent predictors of long-term TBWL less than 20 per cent. Diabetes remission was observed in 39 per cent SO and 40.9 per cent MO patients (P = 0.335) at 10 years, and all patients had a significant lipid profile improvement.
Substantial improvement in co-morbidities was observed in all patients 10 years after RYGB. Total weight loss was similar in SO and MO patients, leaving SO patients with higher BMI. Suboptimal TBWL 5 years after surgery in SO, especially female patients, may warrant prompt reassessment to improve long-term outcomes.
尽管 Roux-en-Y 胃旁路术（RYGB）在全球范围内广泛应用，但对于 BMI 大于 50kg/m2 的患者，其疗效仍存在争议。本文旨在评估 RYGB 在超级肥胖（SO；BMI＞50kg/m2）患者中的长期（10 年或以上）减重效果和代谢结果，并与病态肥胖（MO；BMI 为 35-50kg/m2）患者进行比较。
本研究回顾性分析了 1999 年至 2008 年间接受原发性 RYGB 手术的成年患者前瞻性随访队列。比较了 SO 和 MO 患者的长期减重和代谢参数，并对 SO 患者进行了性别特异性亚组分析。多因素逻辑回归分析评估了长期减重效果不佳的独立预测因素。
在纳入的 957 例患者中，有 193 例（20.2%）为 SO（平均 BMI 为 55.3kg/m2，MO 患者为 43.3kg/m2）。在 86.3%的患者完成 10 年随访时，SO 患者的 BMI 仍较高（平均 39.1kg/m2，MO 患者为 30.8kg/m2，P＜0.001），尽管总体重减轻率（TBWL%）相似（28.3%比 28.8%，P=0.644）。男性 SO 患者 10 年 TBWL%较高，而初始 BMI 大于 50kg/m2 和低 5 年 TBWL%是长期 TBWL%低于 20%的独立预测因素。10 年后，SO 患者的糖尿病缓解率为 39%，MO 患者为 40.9%（P=0.335），所有患者的血脂谱均显著改善。
RYGB 术后 10 年，所有患者的合并症均得到显著改善。SO 和 MO 患者的总减重效果相似，SO 患者的 BMI 仍较高。SO 患者术后 5 年 TBWL 不理想，尤其是女性患者，可能需要及时重新评估以改善长期结果。
