McClelland Paul H, Jawed Mohsin, Kabata Krystyna, Zenilman Michael E, Gorecki Piotr
Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, 506 Sixth Street, Brooklyn, NY, 11215, USA.
Surg Endosc. 2023 Dec;37(12):9427-9440. doi: 10.1007/s00464-023-10366-6. Epub 2023 Sep 7.
Laparoscopic Roux-en-Y gastric bypass (LRYGB) is the gold-standard bariatric procedure with proven efficacy in morbidly obese populations. While the short-term benefits of LRYGB have been well-documented, durable weight loss and long-term resolution of obesity-related comorbidities have been less clearly described.
This single-center study prospectively reports weight loss and comorbidity resolution in patients undergoing LRYGB between August 2001 and September 2007 with at least 15-year follow-up. Data were collected at the time of surgery; 1, 3, 6, and 12 months postoperatively; and then annually thereafter.
A total of 486 patients were included in this analysis. Patients were predominantly female (88.7%), and the median age was 36.0 [IQR 29.0-45.0] years. Patients were ethnically diverse, including Black/African American (43.6%), White/Caucasian (35.0%), Hispanic (18.3%), and other backgrounds (3.1%). Mean preoperative weight and body mass index were 133.0 ± 21.9 kg and 48.4 ± 6.5 kg/m, and the median number of comorbidities was 6.0 [IQR 4.0-7.0]. Follow-up rates at 1, 5, 10, and 15 years were 75.3%, 37.2%, 35.2%, and 18.9%, respectively. On average, maximum percentage total weight loss (%TWL) occurred 2 years postoperatively (- 36.2 ± 9.5%), and ≥ 25% TWL was consistently achieved at 1, 5, 10, and 15-year time intervals (- 28.0 ± 13.0% at 15 years). Patients with comorbidities experienced improvement or resolution of their conditions within 1 year, including type 2 diabetes mellitus (83/84, 98.8%), obstructive sleep apnea (112/116, 96.6%), hypertension (142/150, 94.7%), and gastroesophageal reflux disease (217/223, 97.3%). Rates of improved/resolved comorbidities remained consistently high through at least 10 years after surgery.
LRYGB provides durable weight loss for at least 15 years after surgery, with stable average relative weight loss of approximately 25% from baseline. This outcome corresponds with sustainable resolution of obesity-related comorbidities for at least 10 years after the initial operation.
腹腔镜Roux-en-Y胃旁路术（LRYGB）是治疗病态肥胖人群的金标准减肥手术，其疗效已得到证实。虽然LRYGB的短期益处已有充分记录，但持久的体重减轻和肥胖相关合并症的长期缓解情况描述得并不那么清晰。
这项单中心研究前瞻性报告了2001年8月至2007年9月期间接受LRYGB且至少随访15年的患者的体重减轻情况和合并症缓解情况。在手术时、术后1、3、6和12个月收集数据，此后每年收集一次。
本分析共纳入486例患者。患者以女性为主（88.7%），中位年龄为36.0岁[四分位间距29.0 - 45.0岁]。患者种族多样，包括黑人/非裔美国人（43.6%）、白人/高加索人（35.0%）、西班牙裔（18.3%）和其他背景（3.1%）。术前平均体重和体重指数分别为133.0±21.9kg和48.4±6.5kg/m²，合并症中位数为6.0[四分位间距4.0 - 7.0]。1、5、10和15年的随访率分别为75.3%、37.2%、35.2%和18.9%。平均而言，术后2年出现最大总体重减轻百分比（%TWL）（-36.2±9.5%），在1、5、10和15年时间间隔均持续实现≥25%TWL（15年时为-28.0±13.0%）。患有合并症的患者在1年内病情得到改善或缓解，包括2型糖尿病（83/84，98.8%）、阻塞性睡眠呼吸暂停（112/116，96.6%）、高血压（142/150，94.7%）和胃食管反流病（217/223，97.3%）。术后至少10年内，合并症改善/缓解率一直保持在较高水平。
LRYGB术后至少15年能实现持久的体重减轻，平均相对体重从基线稳定下降约25%。这一结果与肥胖相关合并症在初次手术后至少10年的可持续缓解相一致。
