Obesity Research Unit, Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Departement of Internal Medicine, Helsinki University Hospital, Helsinki, Finland.
Obesity (Silver Spring). 2023 Dec;31(12):2909-2923. doi: 10.1002/oby.23852.
Although it has been suggested that one-anastomosis gastric bypass (OAGB) is metabolically superior to the "gold standard," i.e., Roux-en-Y gastric bypass (RYGB), there is little robust evidence to prove it. Because this result may arise from the typically longer length of bypassed intestine in OAGB, here, the authors standardized the bypass length in RYGB and OAGB and compared weight loss and metabolic outcomes in a randomized controlled trial.
The authors randomized 121 bariatric patients to RYGB (n = 61) or OAGB (n = 60) in two Finnish University Hospitals and measured weight; body composition; metabolic features (insulin sensitivity, lipids, inflammation, nutrition); and comorbidities before and 6 and 12 months after the operation.
Total weight loss was similar in RYGB and OAGB at 6 months (mean: 21.2% [95% CI: 19.4-23.0] vs. 22.8% [95% CI: 21.5-24.1], p = 0.136) and 12 months (25.4% [95% CI: 23.4-27.5] vs. 26.1% [95% CI: 24.2-28.9], p = 0.635). Insulin sensitivity, lipids, and inflammation improved similarly between the groups (p > 0.05). Remission of type 2 diabetes and hypercholesterolemia was marked and similar (p > 0.05) but the use of antihypertensive medications was lower (p = 0.037) and hypertension tended to improve more (p = 0.053) with RYGB versus OAGB at 12 months. Higher rates of vitamin D-25 deficiency (p < 0.05) and lower D-25 levels were observed with OAGB versus RYGB throughout the follow-up (p < 0.001). No differences in adverse effects were observed.
RYGB and OAGB were comparable in weight loss, metabolic improvement, remission of diabetes and hypercholesterolemia, and nutrition at 1-year follow-up. Vitamin D-25 deficiency was more prevalent with OAGB, whereas reduction in antihypertensive medications and hypertension was greater with RYGB. There is no need to change the current practices of RYGB in favor of OAGB.
尽管有人认为单吻合胃旁路术（OAGB）在代谢方面优于“金标准”，即 Roux-en-Y 胃旁路术（RYGB），但目前几乎没有强有力的证据证明这一点。由于 OAGB 通常具有更长的旁路肠长度，因此，作者在 RYGB 和 OAGB 中标准化了旁路长度，并在一项随机对照试验中比较了减重和代谢结果。
作者将 121 名肥胖症患者随机分配至两所芬兰大学医院的 RYGB（n=61）或 OAGB（n=60）组，并在手术前和术后 6 个月和 12 个月测量体重、身体成分、代谢特征（胰岛素敏感性、脂质、炎症、营养）和合并症。
6 个月时，RYGB 和 OAGB 的总减重相似（平均：21.2%[95%CI：19.4-23.0] vs. 22.8%[95%CI：21.5-24.1]，p=0.136）和 12 个月时（25.4%[95%CI：23.4-27.5] vs. 26.1%[95%CI：24.2-28.9]，p=0.635）。两组的胰岛素敏感性、脂质和炎症均得到相似改善（p>0.05）。2 型糖尿病和高胆固醇血症的缓解显著且相似（p>0.05），但与 OAGB 相比，使用降压药物较少（p=0.037），高血压在 12 个月时也有改善（p=0.053）。OAGB 组维生素 D-25 缺乏的发生率更高（p<0.05），且在整个随访过程中 D-25 水平更低（p<0.001）。未观察到不良事件存在差异。
在 1 年随访时，RYGB 和 OAGB 在减重、代谢改善、糖尿病和高胆固醇血症缓解以及营养方面无差异。OAGB 组维生素 D-25 缺乏更为常见，而 RYGB 组降压药物和高血压的减少更为明显。没有必要改变 RYGB 的现行实践转而支持 OAGB。
