Benaiges David, Calzada Max, Casajoana Anna, Deza Belen, Pera Manuel, Climent Elisenda, Roux Juana A Flores Le, Beisani Marc, Olano Miguel, Pérez-Vega Karla A, Pedro-Botet Juan, Goday Albert
Department of Endocrinology and Nutrition, Hospital del Mar, Passeig Marítim, 25-29, 08003 Barcelona, Spain.
Department of Medicine, Universitat Pompeu Fabra, Plaça de la Mercè, 10-12, 08002 Barcelona, Spain.
J Clin Med. 2025 Jul 10;14(14):4901. doi: 10.3390/jcm14144901.
: Many patients with obesity require conversion bariatric surgery (CBS) after sleeve gastrectomy (SG). The objective of this study was to assess the evolution of LDL cholesterol and other cardiometabolic parameters in patients who have undergone an SG and require a CBS, as the metabolic effects of such conversion procedures remain insufficiently understood. : A retrospective analysis was conducted in a non-randomized prospective cohort of patients with severe obesity who were previously treated with SG and undergoing CBS. Changes in LDL cholesterol levels after SG were compared to those following CBS using repeated-measures ANOVA. : Twenty-eight patients were included (mean age 44.5 ± 7.2 years; 68% female; mean BMI 47.3 ± 7.2 kg/m). Of these, 57% underwent Roux-en-Y gastric bypass (RYGB), and 43% underwent single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) as conversion procedures. The mean time between SG and CBS was 93.5 ± 45.3 months for RYGB and 31.0 ± 45.2 months for SADI-S. The change in LDL cholesterol pre- vs. post-SG was 3.3 mg/dL (95% CI: -13.6 to 20.1), whereas the change pre- vs. post-CBS was -25.7 mg/dL (95% CI: -37.5 to -13.9) ( < 0.001). Remission of high LDL-C was 18.8% after SG and 73.3% after CBS ( = 0.023). The cardiometabolic profile showed a marked improvement profile during the SG period, followed by maintenance of these improvements during the CBS period. : CBS (with either RYGB or SADI-S) results in a reduction in LDL-C, in contrast to the initial surgery with SG. However, CBS does not appear to provide additional benefits over SG in terms of other cardiometabolic parameters.
许多肥胖患者在接受袖状胃切除术（SG）后需要进行减重代谢修正手术（CBS）。本研究的目的是评估接受过SG且需要CBS的患者中低密度脂蛋白胆固醇（LDL胆固醇）及其他心脏代谢参数的变化情况，因为此类修正手术的代谢效应仍未得到充分了解。
对一个非随机前瞻性队列中曾接受SG且正在接受CBS的重度肥胖患者进行回顾性分析。使用重复测量方差分析比较SG后与CBS后LDL胆固醇水平的变化。
纳入了28例患者（平均年龄44.5±7.2岁；68%为女性；平均体重指数47.3±7.2kg/m²）。其中，57%接受了Roux-en-Y胃旁路术（RYGB），43%接受了单吻合口十二指肠空肠旁路术联合袖状胃切除术（SADI-S）作为修正手术。RYGB组SG与CBS之间的平均时间为93.5±45.3个月，SADI-S组为31.0±45.2个月。SG前与SG后LDL胆固醇的变化为3.3mg/dL（95%CI：-13.6至20.1），而CBS前与CBS后LDL胆固醇的变化为-25.7mg/dL（95%CI：-37.5至-13.9）（P<0.001）。SG后高LDL-C缓解率为18.8%，CBS后为73.3%（P=0.023）。心脏代谢指标在SG期间有显著改善，且在CBS期间保持这些改善。
与最初的SG手术相比，CBS（无论是RYGB还是SADI-S）可降低LDL-C。然而，CBS在其他心脏代谢参数方面似乎并未比SG提供更多益处。
