't Hart J W H, Noordman B J, Birnie E, Smulders J F, Nienhuijs S, Dunkelgrün M, Zengerink J F, Friskes I A M, Mannaerts G H H, Verhoef C, Apers J A, Biter L U
Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Surgery, Erasmus Medical Centre, Rotterdam, the Netherlands.
Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
Eur J Intern Med. 2025 Jun 18. doi: 10.1016/j.ejim.2025.06.006.
Limited information is available on long-term quality of life (QoL) outcomes after sleeve gastrectomy compared to Roux-en-Y gastric bypass.
These techniques were compared in an open-label randomised controlled trial. This paper focuses on generic health-related QoL (HRQoL) using the 36-Item Short Form Health Survey and EuroQol-5 Dimension 3-Level questionnaires and disease-specific QoL (DSQoL), using the Moorehead-Ardelt questionnaire (specifically designed for individuals with obesity to assesses self-esteem, physical activity, work performance, sexual life, eating behaviour, and social interactions)the Gastroesophageal Reflux Disease Questionnaire (GERD-Q); the Gastrointestinal Quality of Life Index (GIQLI); and the Asthma Control Questionnaire. Simple carbohydrate consumption was assessed with the Dutch Sweet Eating Questionnaire. Measurements were taken preoperatively, 2 months post-surgery, and annually up to 5 years. Analyses used a linear mixed model. Cohen's d (CD) effect sizes indicate small (0∙2), medium (0∙5), and large (0∙8) effects. Dutch Trial Register NTR4741.
From 2013 until 2017, 628 patients were randomised between sleeve gastrectomy (n = 312) and Roux-en-Y gastric bypass (n = 316). Minimal follow-up was 5 years (last follow-up July 29th, 2022). Mean age was 43 [SD, 11] years; mean BMI 43∙5 [SD, 4∙7] and 81∙8 % were women. No clinically relevant differences in generic HRQoL were observed. Moorehead-Ardelt scored higher in the bypass group at 2 years (difference 0∙4, [95 % CI -0∙6 to -0∙1], P=.002, CD -0∙3), without statistically differences later on. GERD-Q scores were consistently better in the bypass group at all time points and remained higher after 5 years (difference 1∙5, [95 % CI 0∙7 to 2∙3], P<.001, CD 0∙3). GIQLI showed a statistically significant better outcome in the bypass group after 4 and 5 years (difference -4∙6, [95 % CI -8∙7 to -0∙4], P = 0.032, CD -0∙17). Sweet-eating showed no statistically significant differences over time.
For patients living with severe obesity, sleeve gastrectomy and Roux-en-Y gastric bypass overall showed good long-term HRQoL and DSQoL outcomes. Roux-en-Y gastric bypass was associated with less GERD-related symptoms. Factors such as GERD should be considered when choosing the type of surgery.
与 Roux-en-Y 胃旁路术相比，关于袖状胃切除术长期生活质量（QoL）结果的信息有限。
在一项开放标签随机对照试验中对这些技术进行了比较。本文重点关注使用 36 项简短健康调查问卷和欧洲五维健康量表 3 级问卷的一般健康相关生活质量（HRQoL），以及使用穆尔黑德 - 阿德尔特问卷（专门为肥胖个体设计，用于评估自尊、身体活动、工作表现、性生活、饮食行为和社交互动）、胃食管反流病问卷（GERD-Q）、胃肠道生活质量指数（GIQLI）和哮喘控制问卷的疾病特异性生活质量（DSQoL）。使用荷兰甜食消费问卷评估简单碳水化合物的摄入量。在术前、术后 2 个月以及每年直至 5 年进行测量。分析采用线性混合模型。科恩 d（CD）效应大小表示小（0∙2）、中（0∙5）和大（0∙8）效应。荷兰试验注册编号 NTR4741。
从 2013 年到 2017 年，628 名患者被随机分配接受袖状胃切除术（n = 312）和 Roux-en-Y 胃旁路术（n = 316）。最短随访时间为 5 年（最后一次随访时间为 2022 年 July 29 日）。平均年龄为 43 [标准差，11] 岁；平均体重指数为 43∙5 [标准差，4∙7]，81∙8%为女性。在一般 HRQoL 方面未观察到临床相关差异。穆尔黑德 - 阿德尔特问卷在 2 年时旁路组得分更高（差异 0∙4，[95%置信区间 -0∙6 至 -0∙1]，P = 0.002，CD -0∙3）。之后无统计学差异。GERD-Q 评分在所有时间点旁路组均持续更好，5 年后仍更高（差异 1∙5，[95%置信区间 0∙7 至 2∙3]，P < 0.001，CD 0∙3）。GIQLI 在 4 年和 5 年后旁路组显示出统计学上显著更好的结果（差异 -4∙6，[95%置信区间 -8∙7 至 -0∙4]，P = 0.032，CD -0∙17）。甜食消费随时间无统计学显著差异。
对于重度肥胖患者，袖状胃切除术和 Roux-en-Y 胃旁路术总体显示出良好的长期 HRQoL 和 DSQoL 结果。Roux-en-Y 胃旁路术与较少的 GERD 相关症状相关。在选择手术类型时应考虑 GERD 等因素。
