Department of Precision and Regenerative Medicine and Jonic Area (DiMePRe-J), General Surgery Unit "M. Rubino," University of Bari Aldo Moro, Bari, Italy.
Obes Facts. 2023;16(5):457-464. doi: 10.1159/000531459. Epub 2023 Aug 14.
Bariatric surgery is a safe and effective treatment for obesity, although in super-obese patients (BMI ≥50 kg/m2) it can become challenging for anatomical and anesthesiologic issues. Several bridging therapies have been proposed to increase preoperative weight loss and decrease perioperative morbidity and mortality. The aim of this study was to compare the efficacy and safety of different two-stage approaches in super-obese patients: laparoscopic sleeve gastrectomy (LSG) following preoperative liraglutide therapy versus LSG with preoperative intragastric balloon (IGB) during a 1-year follow-up.
Clinical records of 86 patients affected by super-obesity who underwent two-stage approach between January 2019 and January 2022 were retrospectively reviewed using a prospectively maintained database. Patients were separated into two groups: those managed with preoperative IGB and those with liraglutide 3.0 mg prior to LSG. Weight (kg), BMI (kg/m2), %EWL, and %EBWL were reported and compared between the two groups at the end of bridging therapy, at 6th month and 12th month postoperatively. Postoperative complications were recorded.
Forty-four patients underwent IGB insertion prior to LSG, while 42 were treated with liraglutide. There were no statistical differences in baseline weight and BMI. At the end of preoperative treatment, the group treated with IGB reported a significant reduction in BMI (47.24 kg/m2 vs. 53.6 kg/m2; p < 0.391) compared to liraglutide group. There were no differences recorded between the two groups concerning postoperative complications. At 6 months, the liraglutide group had lower %EWL (15.8 vs. 29.84; p < 0.05) and %EBWL (27.8 vs. 55.6; p < 0.05) when compared to IGB group. At 12 months, the IGB preserved with higher %EWL (39.9 vs. 25; p < 0.05) and %EBWL (71.2 vs. 42; p < 0.05).
A two-stage therapeutic approach with IGB prior to LSG in super-obese patients could be considered an attractive alternative to liraglutide as bridging therapy before bariatric surgery.
减重手术是治疗肥胖症的一种安全有效的方法，尽管对于超级肥胖患者（BMI≥50kg/m2），由于解剖和麻醉问题，手术可能会变得具有挑战性。已经提出了几种桥接治疗方法，以增加术前体重减轻并降低围手术期发病率和死亡率。本研究的目的是比较超级肥胖患者两种两阶段方法的疗效和安全性：术前利拉鲁肽治疗后行腹腔镜袖状胃切除术（LSG）与术前胃内球囊（IGB）期间行 LSG，随访 1 年。
回顾性分析 2019 年 1 月至 2022 年 1 月期间接受两阶段治疗的 86 例超级肥胖患者的临床记录，使用前瞻性维护的数据库。患者分为两组：一组在 LSG 前接受术前 IGB，另一组在 LSG 前接受利拉鲁肽 3.0mg。报告并比较两组在桥接治疗结束时、术后 6 个月和 12 个月时的体重（kg）、BMI（kg/m2）、%EWL 和%EBWL。记录术后并发症。
44 例患者在行 LSG 前插入 IGB，42 例患者接受利拉鲁肽治疗。两组患者的基线体重和 BMI 无统计学差异。在术前治疗结束时，与利拉鲁肽组相比，接受 IGB 治疗的组 BMI 显著降低（47.24kg/m2 vs.53.6kg/m2；p＜0.391）。两组之间在术后并发症方面没有差异。6 个月时，与 IGB 组相比，利拉鲁肽组的%EWL（15.8 vs.29.84；p＜0.05）和%EBWL（27.8 vs.55.6；p＜0.05）较低。12 个月时，IGB 组保留的%EWL（39.9 vs.25；p＜0.05）和%EBWL（71.2 vs.42；p＜0.05）较高。
在超级肥胖患者中，IGB 在前的两阶段治疗方法可作为桥接治疗之前的一种有吸引力的选择，代替利拉鲁肽用于减重手术。
