Brolin R E, Robertson L B, Kenler H A, Cody R P
Department of Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick.
Ann Surg. 1994 Dec;220(6):782-90. doi: 10.1097/00000658-199412000-00012.
The purpose of this study was to learn whether preoperative eating habits can be used to predict outcome after vertical banded gastroplasty (VBG) and Roux-en-Y gastric bypass (RYGB). BACKGROUND SUMMARY: Several independent randomized and sequential studies have reported significantly greater weight loss after RYGB in comparison with VBG. Although the mechanism responsible for weight loss after both procedures is restriction of intake rather than malabsorption, the relationships between calorie intake, food preferences, and postoperative weight loss are not well defined.
During the past 5 years, 138 patients were prospectively selected for either VBG or RYGB, based on their preoperative eating habits. All patients were screened by a dietitian who determined total calorie intake and diet composition before recommending VBG or RYGB. Thirty patients were selected for VBG; the remaining 108 patients were classified as "sweets eaters" or "snackers" and had RYGB. Detailed recall diet histories also were performed at each postoperative visit.
Early morbidity rate was zero after VBG versus 3% after RYGB. There were no deaths. Mean follow-up was 39 +/- 11 months after VBG and 38 +/- 14 months after RYGB. Mean weight loss peaked at 74 +/- 23 lb at 12 months after VBG and 99 +/- 24 lb at 16 months after RYGB (p < or = 0.001). Twelve of 30 VBG patients lost > or = 50% of their excess weight versus 100 of 108 RYGB patients (p < or = 0.0001). Milk/ice cream intake was significantly greater postoperatively in patients who underwent VBG versus patients who underwent RYGB after 6 months (p < or = 0.003), whereas solid sweets intake was significantly greater after VBG during the first 18 months postoperatively (p < or = 0.004). Revision of VBG was performed in 6 of 30 patients (20%) for complications or poor weight loss, whereas only 2 of 108 patients who underwent RYGB required surgical revisions (p < or = 0.001).
These data show that VBG adversely alters postoperative eating behavior toward soft, high-calorie foods, resulting in problematic postoperative weight loss. Conversely, RYGB patients had significantly greater weight loss despite inferior preoperative eating habits. The high rate of surgical revision in conjunction with inconsistent postoperative weight loss has led us to no longer recommend VBG as treatment for morbid obesity.
本研究旨在了解术前饮食习惯是否可用于预测垂直束带胃成形术（VBG）和Roux-en-Y胃旁路术（RYGB）后的手术效果。背景概述：多项独立的随机和序贯研究报告称，与VBG相比，RYGB术后体重减轻更为显著。尽管这两种手术术后体重减轻的机制都是限制摄入量而非吸收不良，但卡路里摄入量、食物偏好与术后体重减轻之间的关系尚未明确界定。
在过去5年中，根据患者的术前饮食习惯，前瞻性地选择了138例患者进行VBG或RYGB手术。所有患者均由营养师进行筛查，营养师在推荐VBG或RYGB之前确定其总卡路里摄入量和饮食构成。30例患者接受VBG手术；其余108例患者被归类为“甜食爱好者”或“零食爱好者”，并接受RYGB手术。每次术后随访时还详细记录饮食史。
VBG术后早期发病率为零，而RYGB术后为3%。无死亡病例。VBG术后平均随访时间为39±11个月，RYGB术后为38±14个月。VBG术后12个月时平均体重减轻峰值为74±23磅，RYGB术后16个月时为99±24磅（p≤0.001）。30例VBG患者中有12例体重减轻超过或等于超重部分的50%，而108例RYGB患者中有100例（p≤0.0001）。术后6个月，接受VBG手术的患者牛奶/冰淇淋摄入量明显高于接受RYGB手术的患者（p≤0.003），而术后前18个月，VBG术后固体甜食摄入量明显更高（p≤0.004）。30例VBG患者中有6例（20%）因并发症或体重减轻不佳而进行了VBG修正手术，而接受RYGB手术的108例患者中只有2例需要手术修正（p≤0.001）。
这些数据表明，VBG会对术后饮食行为产生不利影响，使其倾向于选择软质、高热量食物，导致术后体重减轻出现问题。相反，尽管术前饮食习惯较差，RYGB患者的体重减轻却明显更多。手术修正率高以及术后体重减轻不一致，导致我们不再推荐将VBG作为治疗病态肥胖的方法。
