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  • Title: [Analysis of the 1-year curative efficacy of sleeve gastrectomy, Roux-en-Y gastric bypass, single anastomosis duodenal-ileal bypass with sleeve gastrectomy and biliopancreatic diversion with duodenal switch in patients with super obesity].
    Author: Zhang Z, Wang L, Zhao YH, Jiang T, Zhang ZZ, Wang X, Hu LF, Xiao MH.
    Journal: Zhonghua Wei Chang Wai Ke Za Zhi; 2023 Sep 25; 26(9):859-865. PubMed ID: 37709694.
    Abstract:
    Objective: To evaluate the 1-year postoperative efficacy of four bariatric procedures, namely sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), single anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S), and biliopancreatic diversion with duodenal switch (BPD/DS) for treating super obesity. Methods: In this retrospective observational study, we analyzed the clinical data of 40 patients with super obesity (body mass index [BMI]≥50 kg/m2) who had undergone bariatric surgery in the China-Japan Union Hospital of Jilin University from November 2015 to December 2020. The study cohort consisted of 21 men and 19 women of average age 31.7±9.0 years. The preoperative weight and BMI were (159.2±16.9) kg and (53.4±3.0) kg/m2, respectively. Prior to the surgery, 30 individuals had hypertension, 27 hyperuricemia, 15 type 2 diabetes, 10 abnormally high total cholesterol, 20 abnormally high triglycerides, and 24 abnormally high low-density lipoprotein. We divided the participants into four groups according to the type of operation: SG group (n=16), RYGB group (n=9), SADI-S group (n=9) and BPD/DS group (n=6). We examined the following factors: weight, BMI, excess weight loss (%), total weight loss (%), and remission of preoperative metabolic diseases (including hypertension, hyperuricemia, type 2 diabetes, and hyperlipidemia) 3, 6, and 12 months after surgery. The variables assessed for hypertension were systolic and diastolic blood pressure; for type 2 diabetes, glycated hemoglobin; and for hyperlipidemia, total cholesterol, triglycerides, and low-density lipoprotein 1-year after the surgery. The safety of surgery was also assessed. Results: All patients successfully completed laparoscopic procedures, none of them requiring conversion to laparotomy. The amount of blood loss during surgery was less than 50 mL. Postoperative hospital stay was 6-16 days. There were no deaths during the perioperative period. However, two postoperative complications occurred in the RYGB group, namely bleeding and anastomotic leakage. No complications were detected in the other groups. At 3, 6, and 12 months after surgery, percentage of excess weight loss was 36.6±11.0, 62.4±15.7, and 68.2±16.0 (F=21.830, P<0.001) in the SG group; 30.6±6.9, 42.5±5.8, and 50.6±11.1 (F=13.222, P<0.001) in the RYGB group; 39.7±7.8, 54.6±12.7, and 81.9±12.0 (F=33.821, P<0.001) in the SADI-S group; and 40.2±4.8, 57.7±11.8, and 82.8±14.9 (F=21.552, P<0.001), respectively, in the BPD/DS group. The percentage of excess weight loss increased significantly over the 12-month observation period in all groups . Compared with before surgery, hypertension and hyperuricemia in the SG, SADI-S, and BPD-DS groups showed significant improvement after one year (all P<0.05). However, only the SADI-S group exhibited a significant decrease in glycosylated hemoglobin concentrations (P=0.038). Only the BPD-DS group showed significant decreases in various indicators of hyperlipidemia (all P<0.05). The improvements in obesity-related complication indexes did not reach statistical significance in the RYGB group (all P>0.05). Conclusion: SG, RYGB, SADI-S and BPD/DS are all safe and effective treatments for super obesity. All of these procedures can improve the associated metabolic diseases to a certain extent. 目的： 评估袖状胃切除术（SG）、Roux-en-Y胃旁路术（RYGB）、单吻合口十二指肠回肠旁路联合袖状胃切除术（SADI-S）和胆胰转流十二指肠转位术（BPD/DS）等4种减重术式治疗超级肥胖患者术后1年的疗效。 方法： 采用回顾性观察性研究，收集2015年11月至2020年12月期间在吉林大学中日联谊医院接受减重手术治疗的40例超级肥胖症［体质指数（BMI）≥50 kg/m2］患者的临床资料，全组男性21例，女性19例，年龄（31.7±9.0）岁，术前体质量和BMI分别为（159.2±16.9）kg和（53.4±3.0）kg/m2。术前合并高血压30例，高尿酸血症27例，2型糖尿病15例，总胆固醇异常升高10例，甘油三酯异常升高20例，低密度脂蛋白异常升高24例。根据减重术式的不同分为SG组（16例）、RYGB组（9例）、SADI-S组（9例）和BPD/DS组（6例）。观察术后3、6和12个月的体质量、体质指数、多余体质量减少百分比（%EWL）、总体质量减少百分比（%TWL）、术前合并的代谢性疾病（包括高血压、高尿酸血症、2型糖尿病、高脂血症等；其中高血压观察指标为收缩压和舒张压；2型糖尿病观察指标为糖化血红蛋白；高脂血症观察指标为总胆固醇、甘油三酯和低密度脂蛋白）在术后1年的缓解情况以及手术安全性。 结果： 所有患者均顺利完成腹腔镜减重手术，无一例中转开腹。术中失血量均不足50 ml，术后住院时间6~16 d。全组均无围手术期死亡病例；除RYGB组有2例出现术后并发症，分别为出血和吻合口漏，其余各组均未发生并发症。4组患者在术后3、6和12个月的体质量和BMI与术前相比均下降，差异均有统计学意义（均P<0.05）；术后3、6和12个月时，SG组%EWL分别为36.6±11.0、62.4±15.7和68.2±16.0（F=21.830，P<0.001）；RYGB组分别为30.6±6.9、42.5±5.8和50.6±11.1（F=13.222，P<0.001）；SADI-S组分别为39.7±7.8、54.6±12.7和81.9±12.0（F=33.821，P<0.001）；BPD/DS组分别为40.2±4.8、57.7±11.8和82.8±14.9（F=21.552，P<0.001），均呈现逐渐增加的趋势，差异均有统计学意义。与术前相比，术后1年SG组、SADI-S组和BPD-DS组的高血压和高血尿酸情况均有所改善（均P<0.05）；但只有SADI-S组的糖化血红蛋白水平降低明显，差异有统计学意义（P=0.038）；只有BPD-DS组的高脂血症各项指标水平均降低明显，差异有统计学意义（均P<0.05）。RYGB组各项肥胖相关代谢病指标的改善情况均未达到统计学意义（均P>0.05）。 结论： SG、RYGB、SADI-S和BPD/DS 4种减重术式治疗超级肥胖患者均安全有效，且均能够一定程度改善其合并的代谢性疾病。.
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