Department of Bariatric and Upper GI Surgery, Royal Infirmary Edinburgh, NHS Lothian, UK.
Surg Laparosc Endosc Percutan Tech. 2024 Oct 1;34(5):466-471. doi: 10.1097/SLE.0000000000001313.
The impact of preoperative weight loss on long-term weight loss outcomes and comorbidity resolution in both laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) are poorly reported. Understanding this relationship is necessary to guide surgeons toward appropriate procedure and patient selection. The present study investigates long-term weight loss outcomes and comorbidity resolution following LSG and LRYGB and investigates the effect of preoperative variables on long-term outcomes.
All patients who underwent LSG and LRYGB (2008-2022) in a tertiary referral centre were followed up prospectively. From 2010, a 12-week intensive preoperative information course (IPIC) became standard practice to optimize preoperative weight loss. Excess weight loss outcomes (EWL≥50% and ≥70%) were compared between LSG and LRYGB using multivariate logistic regression and the effect of preoperative weight loss on weight loss and comorbidity resolution, improvement, and exacerbation were reported.
A total of 319 patients (median age: 49 y; M:F, 75:244) were included (158 LSG: 161 LRYGB). During follow-up, 260 (81.5%) and 163 patients (51.1%) achieved EWL≥50% and ≥70%, respectively. Those with sustained EWL≥50% and EWL≥70% at the end of follow-up were more likely to have underwent a LRYGB versus a LSG (59.6% vs. 40.4%, P=0.002; 61.7% vs. 38.3%, P<0.001). IPIC and higher preoperative weight loss (HR: 2.59 to 3.72, P<0.001) increased rates of EWL≥50% and EWL70% for both procedures. Improvement or resolution of type-2 diabetes were significant (72.7%), but up to 27.3% of patients developed or suffered an exacerbation of a psychiatric illness.
Excess weight loss outcomes are similar for LSG and LRYGB but LRYGB results in higher rates of sustained excess weight loss during long-term follow-up. Preoperative weight loss improves long-term weight loss. Comorbidity resolution is significant but rates of psychiatric illness exacerbation are high following metabolic and bariatric surgery.
腹腔镜袖状胃切除术（LSG）和腹腔镜 Roux-en-Y 胃旁路术（LRYGB）术前体重减轻对长期体重减轻结果和合并症缓解的影响报道甚少。了解这种关系对于指导外科医生进行适当的手术和患者选择是必要的。本研究调查了 LSG 和 LRYGB 后的长期体重减轻结果和合并症缓解情况，并调查了术前变量对长期结果的影响。
在一家三级转诊中心，所有接受 LSG 和 LRYGB（2008-2022 年）的患者均进行前瞻性随访。自 2010 年以来，12 周的强化术前信息课程（IPIC）成为标准做法，以优化术前体重减轻。使用多变量逻辑回归比较 LSG 和 LRYGB 之间的超重减轻结果（EWL≥50%和≥70%），并报告术前体重减轻对体重减轻和合并症缓解、改善和恶化的影响。
共纳入 319 例患者（中位年龄：49 岁；M:F，75:244）（158 例 LSG：161 例 LRYGB）。在随访期间，分别有 260（81.5%）和 163 例（51.1%）患者达到 EWL≥50%和 EWL≥70%。在随访结束时持续达到 EWL≥50%和 EWL≥70%的患者更有可能接受 LRYGB 而非 LSG（59.6% vs. 40.4%，P=0.002；61.7% vs. 38.3%，P<0.001）。IPIC 和更高的术前体重减轻（HR：2.59 至 3.72，P<0.001）增加了两种手术的 EWL≥50%和 EWL70%的发生率。2 型糖尿病的改善或缓解显著（72.7%），但多达 27.3%的患者出现或恶化了精神疾病。
LSG 和 LRYGB 的超重减轻结果相似，但 LRYGB 在长期随访中导致持续超重减轻的发生率更高。术前体重减轻可改善长期体重减轻。合并症缓解显著，但代谢和减重手术后精神疾病恶化的发生率较高。
