MacLean L D, Rhode B M, Sampalis J, Forse R A
Department of Surgery, McGill University, Montreal, Canada.
Am J Surg. 1993 Jan;165(1):155-60; discussion 160-2. doi: 10.1016/s0002-9610(05)80420-9.
A prospective, randomized trial comparing vertical banded gastroplasty (VBG) and vertical gastric bypass (GB) for obesity was completed in 106 patients who did not differ in baseline body mass index (BMI = kg/m2) or length of follow-up. The goal of this surgery was to return patients to within 50% of their ideal weight, i.e., a body mass index less than 35 kg/m2, and to accomplish this while maintaining a low risk for malnutrition as well as other morbidity and mortality. Success was defined as a BMI less than 35 kg/m2 because the mortality risk increases rapidly above this degree of obesity. Surgical failures were encountered in 43% of the 54 patients in the VBG group, all of whom had division between the vertical staple lines. The main causes of failure were stenosis and enlargement of the gastroplasty orifice. Surgery failed in 23% of the GB-treated patients, due to perforation of the vertical staple line. An isolated gastric bypass (IGB) not dependent on staples was performed as the remedial operation for the failures of both VBG and GB. IGB was significantly better than VBG or GB, with a success rate of 83% compared with 39% for VBG and 58% for GB. Subsequent experience since completion of this randomized trial in 54 consecutive patients supports IGB for primary, as well as remedial, operations for the morbidly obese (BMI = 40 to 50 kg/m2), as well as for patients who are super obese (BMI greater than 50 kg/m2).
一项比较垂直捆绑胃成形术（VBG）和垂直胃旁路术（GB）治疗肥胖症的前瞻性随机试验，在106例患者中完成，这些患者在基线体重指数（BMI = kg/m²）或随访时间上没有差异。该手术的目标是使患者体重恢复到理想体重的50%以内，即体重指数小于35 kg/m²，并在保持低营养不良风险以及其他发病率和死亡率的同时实现这一目标。成功定义为BMI小于35 kg/m²，因为超过这个肥胖程度，死亡风险会迅速增加。VBG组54例患者中有43%手术失败，所有失败患者的垂直吻合钉线之间均出现裂开。失败的主要原因是胃成形口狭窄和扩大。GB治疗组有23%的患者手术失败，原因是垂直吻合钉线穿孔。对VBG和GB手术失败的患者均采用不依赖吻合钉的单纯胃旁路术（IGB）作为补救手术。IGB明显优于VBG或GB，成功率为83%，而VBG为39%，GB为58%。自这项随机试验完成后，对54例连续患者的后续经验支持IGB用于病态肥胖（BMI = 40至50 kg/m²）以及超级肥胖（BMI大于50 kg/m²）患者的初次手术和补救手术。
