初治带式 RYGB、带式长肢 RYGB 和复治 B-RYGB:一年随访的体重减轻情况和并发症

Andries Van Huele, Jane N. Buchwald, T. McGlennon, Bruno Dillemans
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引用次数: 0

摘要

目的:我们旨在研究原发性带状 Roux-en-Y 胃旁路术(B-RYGB)、原发性带状长肢 RYGB 术(B-LLRYGB)以及 B-RYGB 术后复查的有效性和安全性,以解决 RYGB 术后体重减轻不足(≤ 50.0%)或体重反弹的问题。方法:这是一项单中心、回顾性、比较性分析,研究对象为 III 级肥胖患者[体重指数 (BMI,kg/m2)≥ 40.0 - ≤ 50.0],他们在初次 B-RYGB 或 B-LLRYGB 过程中接受了 MIDCAL® 非可调校准环,或作为翻修绷带手术的一部分接受了 MIDCAL® 非可调校准环。结果:在2017年7月至2021年1月期间,B-RYGB + B-LLRYGB队列的104名患者(中位体重指数(BMI)为49.3 ± 4.6 [40.6-67.8])的平均体重指数(BMI)为30.7 ± 4.8,总体重减轻(TWL)为37.7% ± 7.9%,随访1年的超重体重指数(EBMIL)为77.5% ± 17.2%(P < 0.001)。B-RYGB (n = 53) vs. B-LLRYGB (n = 51) 一年各自的分析结果:平均 BMI 29.4 ± 3.6 vs. 32.4 ± 5.4(P < 0.005),TWL 38.0% ± 7.3% vs. 37.4% ± 8.6%(P = 0.746),EBMIL 80.7% ± 15.0% vs. 73.6% ± 18.9%(P = 0.066)。96名患者(基线体重指数为37.6 ± 5.5 (28.0-59.2))的再手术B-RYGB组 1年平均体重指数为31.7 ± 4.6,TWL为16.2% ± 9.7%,EBMIL为49.3%% ± 40.2%(P < 0.001)。无死亡病例。30天并发症发生率:初次组为0.0%,翻修组为3.8%。长期(中位 577 天)并发症发生率:初治组 2.5%,翻修组 17.7%。结论在对 III 级和 IV 级(≥ 50.0 - ≤ 60.0)肥胖患者进行为期一年的随访时,B-RYGB、B-LLRYGB 和修正 B-RYGB 均能有效减轻体重,且并发症发生率较低。与初治病例相比,复治病例中与腹带相关的并发症更为常见,这可能是由于使用了较小尺寸的腹带。
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Primary banded RYGB, banded long-limb RYGB, and revisional B-RYGB: weight loss and complications at one-year follow-up
Aim : We aimed to study the effectiveness and safety of primary banded Roux-en-Y gastric bypass (B-RYGB), primary banded long-limb RYGB (B-LLRYGB), and revisional B-RYGB to address insufficient post-RYGB excess weight loss (≤ 50.0%) or weight regain. Methods: This was a single-center, retrospective, comparative analysis of weight loss and postoperative complications in patients with class III obesity [body mass index (BMI, kg/m2) ≥ 40.0 - ≤ 50.0] who received the MIDCAL® non-adjustable calibration ring during primary B-RYGB or B-LLRYGB, or as part of a revisional banding procedure. Results: Between July 2017 and January 2021, the B-RYGB + B-LLRYGB cohort of 104 patients (median BMI 49.3 ± 4.6 [40.6-67.8]) achieved a mean BMI of 30.7 ± 4.8, total weight loss (TWL) 37.7% ± 7.9%, and excess BMI loss (EBMIL) of 77.5% ± 17.2% at 1-year follow-up (P < 0.001). One-year respective B-RYGB (n = 53) vs. B-LLRYGB (n = 51) analysis: mean BMI 29.4 ± 3.6 vs. 32.4 ± 5.4 (P < 0.005), TWL 38.0% ± 7.3% vs. 37.4% ± 8.6% (P = 0.746), EBMIL 80.7% ± 15.0% vs. 73.6% ± 18.9% (P = 0.066). The revisional B-RYGB cohort of 96 patients [baseline BMI 37.6 ± 5.5 (28.0-59.2)] attained a 1-year mean BMI of 31.7 ± 4.6, TWL 16.2% ± 9.7%, EBMIL 49.3%% ± 40.2% (P < 0.001). There was no mortality. 30-day complication rates: primary group 0.0%, revisional group 3.8%. Longer-term (median 577 days) complication rates: primary group 2.5%, revisional group 17.7%. Conclusions: At one-year follow-up in patients with class III and IV (≥ 50.0 - ≤ 60.0) obesity, B-RYGB, B-LLRYGB, and revisional B-RYGB were effective in attaining weight loss with a low rate of complications. Band-related complications were more frequent in revisions than in primary cases, likely due to the use of smaller-sized bands.
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