胰高血糖素样肽-1受体激动剂是一种变革性的术前康复工具，可帮助接受择期疝气修补术的肥胖患者减肥。
GLP-1 receptor agonists are a transformative prehabilitation tool for weight loss in obese patients undergoing elective hernia repair.
作者信息
Spurzem Graham J, Broderick Ryan C, Ruiz-Cota Patricia, Hollandsworth Hannah M, Sandler Bryan J, Horgan Santiago, Grunvald Eduardo, Jacobsen Garth R
机构信息
Department of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, CA, USA.
Division of General Internal Medicine, Bariatric and Metabolic Institute, University of California San Diego, San Diego, CA, USA.
出版信息
Surg Endosc. 2025 Jan;39(1):440-447. doi: 10.1007/s00464-024-11308-6. Epub 2024 Oct 5.
BACKGROUND
Obesity is an independent risk factor for complications after abdominal hernia repair. Glucagon-like-peptide-1 (GLP-1) receptor agonists are gaining popularity as pharmacologic weight loss adjuncts and may help patients reach weight loss goals for surgery. We examine our early experience utilizing GLP-1 agonists versus lifestyle modifications alone to achieve weight loss in patients before elective hernia repair.
METHODS
This single-center, retrospective review identified obese patients who underwent elective hernia repair from 2014 to 2023. Patients were asked to achieve a BMI ≤ 33 kg/m before surgery. Patients who lost weight with GLP-1 therapy in addition to lifestyle changes were compared to a control cohort that achieved similar preoperative weight loss without GLP-1 therapy. Primary outcome was mean time from GLP-1 agonist initiation and initial surgery clinic visit to surgery. Secondary outcomes were 30-day morbidity, mortality, and reoperation rates, and hernia recurrence.
RESULTS
Forty-six patients with ventral/incisional, flank, umbilical, parastomal, inguinal, and hiatal hernias were identified (GLP-1 N = 24, control N = 22). 81.8% (N = 18) of controls had a ventral/incisional hernia, compared to 45.8% (N = 11) of GLP-1 patients (p = 0.03). Mean BMI at GLP-1 agonist initiation was similar to mean BMI at initial clinic visit for controls (38.1 ± 4.9 vs 38.2 ± 2.7 kg/m, p = 0.66). Preoperative mean percentage total weight loss (14.9 ± 7.5 vs 12.4 ± 6.9 kg, p = 0.39) and mean BMI reduction (6.0 ± 3.8 vs 4.9 ± 2.3 kg/m, p = 0.43) were similar between groups. The mean time from GLP-1 agonist initiation to surgery was significantly shorter than initial clinic visit to surgery for controls (6.3 ± 4.0 vs 14.7 ± 17.6 months, p = 0.03). There was no statistically significant difference in time from initial clinic visit to surgery between groups (7.6 ± 4.4 vs 14.7 ± 17.6 months, p = 0.06). There was no significant difference in 30-day morbidity between groups (8.3 vs 27.3%, p = 0.13).
CONCLUSION
GLP-1 agonists accelerate preoperative weight loss for obese hernia patients without negatively impacting postoperative outcomes.
背景
肥胖是腹部疝修补术后并发症的独立危险因素。胰高血糖素样肽-1（GLP-1）受体激动剂作为药物减肥辅助剂越来越受欢迎，可能有助于患者实现手术减肥目标。我们研究了我们早期使用GLP-1激动剂与单纯生活方式改变相比，在择期疝修补术前帮助患者减肥的经验。
方法
这项单中心回顾性研究确定了2014年至2023年接受择期疝修补术的肥胖患者。要求患者在手术前将体重指数（BMI）降至≤33kg/m²。将除生活方式改变外还通过GLP-1治疗减重的患者与未接受GLP-1治疗但术前体重减轻相似的对照组进行比较。主要结局是从开始使用GLP-1激动剂到首次手术门诊就诊至手术的平均时间。次要结局包括30天发病率、死亡率、再次手术率和疝复发率。
结果
共确定了46例患有腹侧/切口疝、侧腹壁疝、脐疝、造口旁疝、腹股沟疝和食管裂孔疝的患者（GLP-1组n = 24，对照组n = 22）。对照组81.8%（n = 18）为腹侧/切口疝，而GLP-1组为45.8%（n = 11）（p = 0.03）。开始使用GLP-1激动剂时的平均BMI与对照组首次门诊就诊时的平均BMI相似（38.1±4.9 vs 38.2±2.7kg/m²，p = 0.66）。两组术前平均总体重减轻百分比（14.9±7.5 vs 12.4±6.9kg，p = 0.39）和平均BMI降低值（6.0±3.8 vs 4.9±2.3kg/m²，p = 0.43）相似。从开始使用GLP-1激动剂到手术的平均时间显著短于对照组从首次门诊就诊到手术的时间（6.3±4.0 vs 14.7±17.6个月，p = 0.03）。两组从首次门诊就诊到手术的时间差异无统计学意义（7.6±4.4 vs 14.7±17.6个月，p = 0.06）。两组30天发病率差异无统计学意义（8.3% vs 27.3%，p = 0.13）。
结论
GLP-1激动剂可加速肥胖疝患者术前体重减轻，且对术后结局无负面影响。
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