Division of General Surgery, Department of Surgery/Bariatric and Metabolic Surgery and Weight Management Center, Tri‑Service General Hospital, National Defense Medical Center, Taipei.
Medical Weight Loss Center, China Medical University Hsinchu Hospital, Hsinchu.
Int J Surg. 2024 Sep 1;110(9):5563-5573. doi: 10.1097/JS9.0000000000001631.
Metabolic bariatric surgery offers enduring weight reduction and alleviation of obesity-related comorbidities, including dyslipidemia, diabetes, hypertension, and major adverse cardiovascular events (MACE). Long-term data on one-anastomosis gastric bypass (OAGB) and single-anastomosis duodenal-jejunal bypass with sleeve gastrectomy (SADJB-SG) is lacking, necessitating this investigation.
In this multicenter prospectively-collected retrospective observational study, 830 adult Taiwanese patients (682 OAGB, 148 SADJB-SG) who underwent surgery from 1 January 2011 to 31 December 2017, were initially identified. Following protocol, 224 patients (177 OAGB, 47 SADJB-SG) with complete follow-up data at various intervals up to 3 years after surgery were included in the final analysis. The study's primary focus is to evaluate the long-term safety, efficacy, and durability of OAGB and SADJB-SG in promoting weight loss and diabetes remission. Additionally, changes in 10-year and lifetime risks of MACE before and 3-year after surgery are assessed using Taiwan MACE risk prediction model and the China-PAR project model.
SADJB-SG patients exhibit higher diabetes prevalence, lower BMI, and more severe diabetes compared to OAGB. Both groups demonstrate significant improvements in BMI, diabetes, hypertension, and dyslipidemia three years after surgery, with the most substantial improvements occurring in the second year. The Taiwan MACE risk model reveals a significant reduction in 10-year MACE and stroke risks for both groups. The China-PAR project model indicates a synchronized reduction in atherosclerotic cardiovascular disease 10-year and lifetime risk in both OAGB and SADJB-SG groups.
OAGB and SADJB-SG exhibit sustained improvements in weight reduction and obesity-related comorbidities over 3 years after surgery. Notably, both procedures contribute to a substantial reduction in 10-year MACE, stroke, and atherosclerotic cardiovascular disease risks. These findings underscore the efficacy of OAGB and SADJB-SG in the context of metabolic bariatric surgery.
代谢减重手术可持久减轻体重并缓解肥胖相关合并症，包括血脂异常、糖尿病、高血压和主要不良心血管事件（MACE）。一吻合胃旁路术（OAGB）和单吻合十二指肠空肠旁路术加袖状胃切除术（SADJB-SG）的长期数据尚缺乏，因此需要进行此项研究。
在这项多中心前瞻性回顾性观察研究中，最初确定了 2011 年 1 月 1 日至 2017 年 12 月 31 日期间接受手术的 830 例成年台湾患者（OAGB 组 682 例，SADJB-SG 组 148 例）。根据方案，将 224 例（OAGB 组 177 例，SADJB-SG 组 47 例）在手术后不同时间点随访数据完整的患者纳入最终分析。该研究的主要重点是评估 OAGB 和 SADJB-SG 在促进体重减轻和糖尿病缓解方面的长期安全性、疗效和持久性。此外，还使用台湾 MACE 风险预测模型和中国 PAR 项目模型评估了手术前和术后 3 年时 10 年和终生 MACE 风险的变化。
SADJB-SG 患者的糖尿病患病率较高，BMI 较低，糖尿病也更严重。两组患者在手术后 3 年时 BMI、糖尿病、高血压和血脂异常均显著改善，第二年改善最明显。台湾 MACE 风险模型显示两组 10 年 MACE 和中风风险显著降低。中国 PAR 项目模型表明，OAGB 和 SADJB-SG 两组的 10 年和终生动脉粥样硬化性心血管疾病风险同步降低。
OAGB 和 SADJB-SG 在手术后 3 年内持续改善体重减轻和肥胖相关合并症。值得注意的是，两种手术均可显著降低 10 年 MACE、中风和动脉粥样硬化性心血管疾病风险。这些发现强调了 OAGB 和 SADJB-SG 在代谢减重手术中的疗效。
