Wael Mohamed, Kandel Mohamed Mosaad, Altabbaa Hashem, Elkeleny Mostafa Refaie
Alexandria Main University Hospital, Alexandria, Egypt.
Alexandria University, Alexandria, Egypt.
Obes Surg. 2025 May 28. doi: 10.1007/s11695-025-07930-5.
Individuals with clinically severe obesity and a BMI ≥ 60 kg/m (class V obesity) have a higher incidence of both obesity-related comorbidities and anticipated operative difficulty, with a subsequent higher risk of perioperative morbidity and mortality and a longer hospital stay. In patients with class V obesity, the definitive bariatric procedure is still a matter of debate. This study compared surgical procedures (SASI vs. RYGB) in people with class V obesity. The primary objective was to compare weight loss after both procedures over a 1-year follow-up. Secondary outcomes included the evaluation of the incidence of the operative time (skin-to-skin), postoperative complications, duration of hospital stay, rate of conversion to the open technique, and quality of life, as well as amelioration of obesity-related comorbidities.
From January 2019 to December 2022, the data of 73 consecutive patients with class V obesity was collected, who underwent either standard RYGB (n = 40) or SASI (n = 33) at the General Surgery Department of Alexandria University Hospital and some non-governmental hospitals.
There was no statistically significant difference between both groups as regards mean age (p = 0.012), sex (p = 0.250), preoperative BMI (p = 0.754), or preoperative incidence of obesity-related co-morbidities. The SASI procedure showed a statistically shorter operative time (p < 0.001). There was no significant difference between the two groups as regards the incidence of postoperative surgical complications, either early cmplications (21.1% and 20% in both SASI and RYGB, respectively, p = 0.770) or late (beyond 30 days) complications (15.2% and 15% in SASI and RYGB, respectively, p = 1.000), with neither conversion nor intra-operative mortality in both groups. However, the SASI group showed a significant shorter postoperative hospital stay (p < 0.001). During the follow-up period, both operations demonstrated a significant overall resolution of pre-operative obesity-related comorbidities, a significant increase in postprandial 6 weeks postoperative GLP-1 with statistically more rise in the SASI group in the postprandial GLP-1 compared to the RYGB group (p < 0.001). There was no mortalities in both group during the follow up duration.
In patients with class V obesity, the SASI procedure had a statistically shorter operative time (skin-to-skin) and a shorter hospital stay compared to RYGB. Both procedures resulted in satisfactory weight loss, as well as comparable improvements in obesity-related comorbidities.
临床重度肥胖且体重指数（BMI）≥60 kg/m²（V级肥胖）的个体，肥胖相关合并症的发生率较高，手术难度预期也较大，因此围手术期发病和死亡风险更高，住院时间更长。对于V级肥胖患者，最终的减肥手术方案仍存在争议。本研究比较了V级肥胖患者的手术方式（单吻合口胃袖状切除术[SASI]与 Roux-en-Y 胃旁路术[RYGB]）。主要目的是比较两种手术方式在1年随访期后的体重减轻情况。次要结局包括评估手术时间（皮肤切开至皮肤缝合）、术后并发症发生率、住院时间、转为开放手术的比例、生活质量，以及肥胖相关合并症的改善情况。
收集了2019年1月至2022年12月期间，在亚历山大大学医院普通外科和一些非政府医院接受标准RYGB（n = 40）或SASI（n = 33）的73例连续V级肥胖患者的数据。
两组在平均年龄（p = 0.012）、性别（p = 0.250）、术前BMI（p = 0.754）或术前肥胖相关合并症发生率方面，差异均无统计学意义。SASI手术的手术时间在统计学上显著更短（p < 0.001）。两组术后手术并发症发生率，无论是早期并发症（SASI组和RYGB组分别为21.1%和20%，p = 0.770）还是晚期（超过30天）并发症（SASI组和RYGB组分别为15.2%和15%，p = 1.000），差异均无统计学意义，两组均无转为开放手术或术中死亡情况。然而，SASI组的术后住院时间显著更短（p < 0.001）。在随访期间，两种手术均显示术前肥胖相关合并症有显著的总体缓解，术后6周餐后胰高血糖素样肽-1（GLP-1）显著升高，与RYGB组相比，SASI组餐后GLP-1升高在统计学上更明显（p < 0.001）。随访期间两组均无死亡病例。
对于V级肥胖患者，与RYGB相比，SASI手术的手术时间（皮肤切开至皮肤缝合）在统计学上显著更短，住院时间也更短。两种手术均能实现令人满意的体重减轻，以及在肥胖相关合并症方面取得相当的改善。
