Futooh Zahraa, ElSafty Mahmoud, Shinkar Ahmed, Orebi Hisham Ahmed, Elghany Rasha Abd Elaziz Abd, Youssef Hoda A A, Sabra Hamdy Khaled, Elkaseer Mohamed, Agwa Mohamed, Mahmoud Elsayed, Ebrahim Ahmed, Bakr Ibrahim Sabry, Nafea Mohamed A, Shalamesh Mohamed, Abosonna Kamal, El-Hady Hany Abdelfatah
Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt.
Faculty of Medicine, Tanta University, Tanta, Egypt.
J Gastrointest Surg. 2025 Aug;29(8):102112. doi: 10.1016/j.gassur.2025.102112. Epub 2025 Jun 3.
This study aimed to compare the efficacy of one-anastomosis gastric bypass (OAGB) and laparoscopic sleeve gastrectomy (LSG) in achieving weight loss and evaluating postoperative micronutrient disturbances in patients with super-obesity.
A single-center retrospective cohort study was conducted using medical records of patients with a body mass index (BMI) of ≥50 kg/m² who underwent either OAGB or LSG.
A total of 92 patients were included in the analysis (53 in the LSG group and 39 in the OAGB). The OAGB group was significantly older than the LSG group (median: 41 vs 33 years, respectively; P =.001). Baseline weight, height, BMI, electrolyte levels, and most biochemical markers were comparable between groups. The LSG group had a significantly shorter operative time than the OAGB group (median: 30 vs 53 min, respectively; P <.0001). Comorbidities were more prevalent in the OAGB group than in the LSG group, with higher rates of diabetes mellitus and hypertension (35.9% vs 3.8%, respectively; P <.0001) and ischemic heart disease (12.8% vs 0.0%, respectively; P =.012). Postoperative hospital stay and overall complication rates were similar (3.8% in the LSG group vs 7.8% in the OAGB group; P =.349). At 12 months, the OAGB group achieved significantly greater %excess body weight loss than the LSG group (86.6% vs 78.2%, respectively; P <.0001). Although early postoperative weight loss was comparable, the OAGB group had a lower median weight at 12 months than the LSG group (78.5 vs 89.0 kg, respectively; P =.003). Postoperative albumin, hemoglobin, ferritin, and zinc levels were significantly lower in the OAGB group than in the LSG group (P ≤.03).
OAGB achieved more significant long-term weight loss than LSG in patients with super-obesity. However, OAGB was associated with a higher risk of micronutrient deficiencies, particularly in iron, vitamin B12, and zinc, than LSG. LSG may be preferable for patients at higher risk of nutritional deficiencies.
本研究旨在比较单吻合口胃旁路术（OAGB）和腹腔镜袖状胃切除术（LSG）在超级肥胖患者中实现体重减轻的效果，并评估术后微量营养素紊乱情况。
采用单中心回顾性队列研究，纳入体重指数（BMI）≥50 kg/m²且接受OAGB或LSG手术的患者的病历。
共有92例患者纳入分析（LSG组53例，OAGB组39例）。OAGB组患者年龄显著大于LSG组（中位数分别为41岁和33岁；P = 0.001）。两组间基线体重、身高、BMI、电解质水平及大多数生化指标具有可比性。LSG组手术时间显著短于OAGB组（中位数分别为30分钟和53分钟；P < 0.0001）。OAGB组合并症比LSG组更普遍，糖尿病和高血压发生率更高（分别为35.9%和3.8%；P < 0.0001），缺血性心脏病发生率也更高（分别为12.8%和0.0%；P = 0.012）。术后住院时间和总体并发症发生率相似（LSG组为3.8%，OAGB组为7.8%；P = 0.349）。在12个月时，OAGB组实现的超重体重减轻百分比显著高于LSG组（分别为86.6%和78.2%；P < 0.0001）。尽管术后早期体重减轻情况相当，但OAGB组在12个月时的中位数体重低于LSG组（分别为78.5 kg和89.0 kg；P = 0.003）。OAGB组术后白蛋白、血红蛋白、铁蛋白和锌水平显著低于LSG组（P≤0.03）。
在超级肥胖患者中，OAGB比LSG实现了更显著的长期体重减轻。然而，与LSG相比，OAGB发生微量营养素缺乏的风险更高，尤其是铁、维生素B12和锌。对于营养缺乏风险较高的患者，LSG可能更可取。
