Department of Surgery C, Sheba Medical Center, Tel Hashomer, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel.
Isr Med Assoc J. 2023 Sep;25(9):612-616.
Long-term outcome data for bariatric surgery in patients with severe obesity (SO) (body mass index [BMI] 50 kg/m2) are scarce.
To compare perioperative morbidity and long-term outcomes between patients with SO and non-SO (NSO).
Patients with SO who underwent primary bariatric surgery with a follow-up 5 years were age- and gender-matched with NSO patients in a retrospective, case-control study. Data included demographics, BMI, co-morbidities, early outcomes, current and nadir weight, co-morbidity status, and general satisfaction.
Of 178 patients, 49.4% were male, mean age 44.5 ± 14 years. Mean preoperative BMI was 54.7 ± 3.6 and 41.8 ± 3.8 kg/m2 in SO and NSO, respectively (P = 0.02). Groups were similar in preoperative characteristics. Depression/anxiety was more prevalent in NSO (12.4% vs. 3.4%, P = 0.03). Obstructive sleep apnea was higher in SO (21.3% vs. 10.1%, P = 0.04). Sleeve gastrectomy was performed most often (80.9%), with a tendency toward bypass in SO (P = 0.05). Early complication rates were: 13.5% in SO and 12.4% in NSO (P = 0.82). Mean follow-up was 80.4 ± 13.3 months. BMI reduction was higher in SO (31.8 ± 5.9 vs. 26.8 ± 4.2 kg/m2, P < 0.001) and time to nadir weight was longer (22.1 ± 21.3 vs. 13.0 ± 12.0 months, P = 0.001). Co-morbidity improvement and satisfaction were similar.
Patients with SO benefited from bariatric surgery with reduced BMI and fewer co-morbidities. No added risk of operative complications was found compared to patients with NSO.
肥胖症（SO）（BMI≥50kg/m2）患者行减重手术的长期结果数据很少。
比较严重肥胖症（SO）和非严重肥胖症（NSO）患者的围手术期发病率和长期结果。
对接受过原发性减重手术并随访时间5 年的 SO 患者进行回顾性病例对照研究，按年龄和性别与 NSO 患者进行匹配。数据包括人口统计学、BMI、合并症、早期结果、当前和最低体重、合并症状态和总体满意度。
在 178 例患者中，49.4%为男性，平均年龄 44.5±14 岁。术前 BMI 平均值分别为 SO 组 54.7±3.6kg/m2和 NSO 组 41.8±3.8kg/m2（P=0.02）。两组在术前特征方面相似。NSO 中抑郁/焦虑更为常见（12.4% vs. 3.4%，P=0.03）。SO 中阻塞性睡眠呼吸暂停更为常见（21.3% vs. 10.1%，P=0.04）。胃袖切除术是最常进行的手术（80.9%），SO 中更倾向于旁路手术（P=0.05）。早期并发症发生率：SO 组为 13.5%，NSO 组为 12.4%（P=0.82）。平均随访时间为 80.4±13.3 个月。SO 组 BMI 下降更多（31.8±5.9 vs. 26.8±4.2kg/m2，P<0.001），体重达到最低所需时间更长（22.1±21.3 vs. 13.0±12.0 个月，P=0.001）。合并症改善和满意度相似。
与 NSO 患者相比，SO 患者行减重手术可降低 BMI，减少合并症，且未发现手术并发症风险增加。
