PDF(Pubmed)
Abstract：
OBJECTIVE: The laparoscopic Roux-en-Y gastric bypass (LRYGB) is one of the standard procedures in metabolic surgery. Different limb lengths have been proposed in the past to maximize weight loss (WL) and reduce metabolic complications. Distal gastric bypass surgery with a very short common channel (CC) (up to 100 cm) has been often criticized due to frequent side effects such as malnutrition, bone weakening and short-bowel syndrome. We introduced a modified version of a distal LRYGB with a 50-70 cm long biliopancreatic limb (BPL) and an intermediate short CC (120-150 cm). Our primary goal was to compare the long-term WL between distal and proximal LRYGB in two cohorts of patients. Secondary outcomes were weight regain (WR), insufficient weight loss (IWL), postoperative complications and metabolic changes 5 years after surgery.
METHODS: In this retrospective study we collected data from 160 patients operated between 2014 and 2015, with a BMI of 37-44 Kg/m2. 101 patients underwent a distal and 59 patients a proximal LRYGB in two bariatric centers. WL was calculated as percent of excess of BMI loss (%EBMIL), loss of body mass index (Delta-BMI), percent of excess weight loss (%EWL) and percent of total weight loss (%TWL). Data were collected 3, 6, 9, 12, 24, 48 and 60 months after surgery.
RESULTS: The distal LRYGB resulted in significantly better 5-year-WL compared to the proximal bypass in terms of %EBMIL (median at 5 years: 83% vs. 65%, p = 0.001), %TWL (median at 5 years: 32% vs. 26%, p = 0.017) and %EWL (median at 5 years: 65% vs. 51%, p = 0.029), with equal major complications and metabolic alterations. In addition, WR was significantly lower in patients with distal bypass (18% vs. 35%, p = 0.032).
CONCLUSIONS: Distal LYRGB with a 120-150 long CC results in better WL and WL-maintenance compared to proximal LRYGB without major side effects after five years.
METHODS: In this retrospective study we collected data from 160 patients operated between 2014 and 2015, with a BMI of 37-44 Kg/m2. 101 patients underwent a distal and 59 patients a proximal LRYGB in two bariatric centers. WL was calculated as percent of excess of BMI loss (%EBMIL), loss of body mass index (Delta-BMI), percent of excess weight loss (%EWL) and percent of total weight loss (%TWL). Data were collected 3, 6, 9, 12, 24, 48 and 60 months after surgery.
RESULTS: The distal LRYGB resulted in significantly better 5-year-WL compared to the proximal bypass in terms of %EBMIL (median at 5 years: 83% vs. 65%, p = 0.001), %TWL (median at 5 years: 32% vs. 26%, p = 0.017) and %EWL (median at 5 years: 65% vs. 51%, p = 0.029), with equal major complications and metabolic alterations. In addition, WR was significantly lower in patients with distal bypass (18% vs. 35%, p = 0.032).
CONCLUSIONS: Distal LYRGB with a 120-150 long CC results in better WL and WL-maintenance compared to proximal LRYGB without major side effects after five years.
摘要：
目的：腹腔镜Roux-en-Y胃旁路术（LRYGB）是代谢外科的标准手术之一。过去已经提出了不同的肢体长度以最大化体重减轻（WL）并减少代谢并发症。由于营养不良等频繁的副作用，具有非常短的公共通道（CC）（长达100厘米）的远端胃旁路手术经常受到批评，骨弱化和短肠综合征。我们引入了远端LRYGB的改良版，该远端LRYGB具有50-70厘米长的胆胰肢（BPL）和中间短CC（120-150厘米）。我们的主要目标是比较两组患者远端和近端LRYGB之间的长期WL。次要结果是体重恢复（WR），失重不足（IWL），术后并发症和术后5年代谢变化。
方法：在这项回顾性研究中，我们收集了2014年至2015年间进行手术的160例患者的数据，BMI为37-44Kg/m2。在两个减肥中心，101例患者接受了远端治疗，59例患者接受了近端LRYGB治疗。WL计算为BMI损失的过量百分比(%EBMIL)，体重指数损失(Delta-BMI)，过量重量损失的百分比(%EWL)和总重量损失的百分比(%TWL)。术后3、6、9、12、24、48和60个月收集数据。
结果：与近端旁路相比，远端LRYGB的5年WL明显更好（5年中位数：83％vs.65%,p=0.001),%TWL（5年中位数：32%与26%,p=0.017）和%EWL（5年时的中位数：65%与51%,p=0.029),具有相同的主要并发症和代谢改变。此外,远端搭桥患者的WR显着降低（18％与35%,p=0.032)。
结论：与近端LRYGB相比，具有120-150长CC的远端LYRGB在5年后可获得更好的WL和WL维持，且无主要副作用。
方法：在这项回顾性研究中，我们收集了2014年至2015年间进行手术的160例患者的数据，BMI为37-44Kg/m2。在两个减肥中心，101例患者接受了远端治疗，59例患者接受了近端LRYGB治疗。WL计算为BMI损失的过量百分比(%EBMIL)，体重指数损失(Delta-BMI)，过量重量损失的百分比(%EWL)和总重量损失的百分比(%TWL)。术后3、6、9、12、24、48和60个月收集数据。
结果：与近端旁路相比，远端LRYGB的5年WL明显更好（5年中位数：83％vs.65%,p=0.001),%TWL（5年中位数：32%与26%,p=0.017）和%EWL（5年时的中位数：65%与51%,p=0.029),具有相同的主要并发症和代谢改变。此外,远端搭桥患者的WR显着降低（18％与35%,p=0.032)。
结论：与近端LRYGB相比，具有120-150长CC的远端LYRGB在5年后可获得更好的WL和WL维持，且无主要副作用。
