Lodewijks Yentl, Luyer Misha, van Montfort Gust, de Zoete Jean-Paul, Smulders Frans, Nienhuijs Simon
Department of Surgery Catharina Hospital Eindhoven The Netherlands.
Obes Sci Pract. 2023 May 10;9(5):493-500. doi: 10.1002/osp4.677. eCollection 2023 Oct.
Multidisciplinary screening of bariatric surgery candidates is recommended, and some centers provide an additional preparation program (APP) to optimize patients preoperatively.
To compare patients with APP to standard care 2 years after primary bariatric surgery regarding postoperative weight loss and resolution of obesity-related comorbidities.
A retrospective cohort study was conducted for patients undergoing primary Roux-en-Y gastric bypass and sleeve gastrectomy between September 2017 and March 2019. The first 12 months patients received an APP, after September 2018, the APP was no longer part of the weight loss trajectory. A multivariable linear regression model was built.
Of the 384 patients receiving an APP advice, 50 were lost to follow up. In total, 192 (57%) received the APP and 142 (43%) received standard care. Percentage total weight loss after 2 years was significantly different, 28.8% for the APP group versus 32% for the standard group ( = 0.001). Postoperative weight loss after 2 years was increased in patients who had a gastric bypass, a higher baseline body mass index, and female gender in multivariable analysis. An APP was predictive for decreased postoperative weight. Diabetes mellitus was in remission significantly more often in the preparation group (84.1% of the cases) compared with the standard group (61.9%, = 0.028).
A weight loss trajectory is at least as effective without additional preparation in terms of 2 years postoperative %TWL for primary gastric bypass and sleeve procedures. For comorbidities, diabetes mellitus was in remission more often in the APP group.
推荐对减肥手术候选人进行多学科筛查，一些中心提供额外的准备计划（APP）以在术前优化患者情况。
比较接受APP的患者与接受标准护理的患者在初次减肥手术后2年的术后体重减轻情况及肥胖相关合并症的缓解情况。
对2017年9月至2019年3月期间接受初次 Roux-en-Y 胃旁路手术和袖状胃切除术的患者进行回顾性队列研究。前12个月患者接受APP，2018年9月之后，APP不再是减肥过程的一部分。建立了多变量线性回归模型。
在384名接受APP建议的患者中，50名失访。总共192名（57%）接受了APP，142名（43%）接受了标准护理。2年后总体体重减轻百分比有显著差异，APP组为28.8%，标准组为32%（P = 0.001）。多变量分析显示，接受胃旁路手术、基线体重指数较高以及女性的患者术后2年体重减轻更多。APP可预测术后体重下降。与标准组（61.9%，P = 0.028）相比，准备组糖尿病缓解的比例显著更高（84.1%的病例）。
就初次胃旁路手术和袖状胃手术术后2年的总体体重减轻百分比而言，没有额外准备的减肥过程至少同样有效。对于合并症，APP组糖尿病缓解的情况更常见。
