Objective To investigate the clinical application value of unsymmetrical four-port laparoscopic sleeve gastrectomy (LSG). Methods The clinical data of 114 patients with obesity who were admitted to Mianyang Central Hospital from June 2021 to May 2022 were retrospective analyzed. All the 114 patients underwent unsymme-trical four-port LSG, and were observed their surgical and postoperative conditions, complications and follow-up the patient’s esthetic satisfaction of wounds at 3 months after surgery. Results All 114 patients underwent unsymmetrical four-port LSG successfully, without conversion to open surgery. The operative time was 68–160 min, average (104.2±26.1) minutes; volume of intraoperative blood loss was 2–50 mL, average (10.7±7.6) mL; the duration of postoperative hospital stay was 3–6 d, average (4.0±0.7) days. Of the 114 patients, 8 patients (7.0%) had fat liquefaction of wounds, 68 patients (59.6%) had postoperative nausea and vomiting in the 24 hours after operation, and all patients had no serious complications such as gastrointestinal bleeding, intraperitoneal hemorrhage, or gastric leakage. One hundred and fourteen patients were followed-up for 3–14 months, with a median follow-up of 6 months. Forty patients (35.1%) had hair loss, 3 patients (2.6%) had mild anemia. Of the 114 patients, 2 (1.8%) were dissatisfied with the cosmetic effects of wounds, 64 (56.1%) were satisfied, and 48 (42.1%) were very satisfied. The satisfaction rate was 98.2% (112/114). Conclusion The unsymmetrical four-port LSG is safe and feasible, it does not affect esthetic satisfaction of wounds.
目的 观察合理营养联合运动干预对肥胖症患者血脂水平的影响，为控制肥胖寻找有效的方法。 方法 将2006年12月-2008年7月收治的72例单纯肥胖症患者随机分为试验组及对照组，每组各36例。试验组按照营养师的要求进行饮食和运动治疗，对照组自行控制饮食和运动，观察期为6个月。在治疗前后分别测量两组患者身高、体重、身体质量指数（BMI）、血压及总胆固醇（TC）、甘油三酰（TG）、低密度脂蛋白胆固醇（LDL-C）及高密度脂蛋白胆固醇（HDL-C），并进行比较。 结果 经过6个月营养联合运动的干预治疗，试验组与对照组相比较，体重、BMI 、TG、TC和LDL-C均降低，而HDL-C升高，差异有统计学意义（Plt;0.05）。 结论 营养联合运动治疗能够有效降低肥胖症患者的体重和BMI，改善其血脂状况，起到调节异常内分泌代谢的作用。
ObjectiveTo investigate the short-term effect of laparoscopic sleeve gastrectomy (LSG) in treatment of obesity in China. MethodsLiteratures about the effect of LSG in treatment of obesity were searched from WanFang, CNKI, PubMed, and Web of Science, then these literatures were filtered according to the inclusive and exclusive criteria and evaluated. Meta analysis was performed based on data extracted from these literatures. ResultsThree hundreds and eighty three cases of LSG were retrieved from 12 literatures. Compared with the preoperative, the body mass index (BMI) was lower in 6 months after LSG (MD=7.56, 95% CI: 5.77-9.34, P < 0.000 01), and compared with 6 months after LSG, the BMI was lower in 12 months after LSG (MD=3.19, 95% CI: 2.20-4.18, P < 0.000 01). Compared with 1 months after LSG, the excess weight loss (EWL%) was higher in 6 months after LSG (MD=-42.77, 95% CI:-45.77--39.77, P < 0.000 01), and compared with 6 months after LSG, EWL% was higher in 12 months after LSG (MD=-19.71, 95% CI:-25.54--13.87, P < 0.000 01). After the LSG, BMI decreased, but EWL% increased over time. ConclusionsIn China, LSG has obviously short-term curative effect in the treatment of obesity.
Objective To investigate the operating skills for treatment of morbidly obese patients with gallstone by using laparoscopic technique meanwhile. Methods From Oct.2006 to Nov.2009, 178 morbidly obese patients undergoing laparoscopic adjustable gastric banding （LAGB）, in which 18 cases combined with gallstone underwent laparoscopic cholecystectomy （LC） meanwhile. Results All of 18 morbidly obese patients with gallstone underwent LAGB and LC successfully, the operating time was (126±24) min and bleeding volume was (50±16) ml. No serious infectious complications occurred, but 3 cases with low-grade nausea and vomiting, 2 cases with adipose tissue liquefaction in incision, and one case with few seroperitoneun， all were cured conservatively. Conclusion Morbidly obese patients with gallstone undergoing LAGB and LC at the same time by changing site of incision is a safe and effective procedure and a feasible technique.
ObjectiveTo investigate the effect of stomach intestinal pylorus sparing surgery in metabolic surgery for weight loss.MethodThe literatures about stomach intestinal pylorus sparing surgery were reviewed by searching domestic and foreign literatures.ResultsIn recent years, stomach intestinal pylorus sparing surgery had been gradually applied in clinical practice. Compared with other weight-loss surgeries, it had better clinical effects in weight reduction and blood glucose control. It not only provided a new surgical treatment for patients with severe obesity, but also promoted the development of weight-loss metabolic surgery.ConclusionAs a new metabolic surgery, stomach intestinal pylorus sparing surgery is safe and feasible for weight loss.
ObjectiveTo explore the effect of laparoscopic sleeve gastrectomy (LSG) on obesity and its comorbidities.MethodThe literatures about LSG in the treatment of obesity and its comorbidities were collected and summarized.ResultsLSG could not only effectively reduce the weight of patients with obesity, but also obviously alleviate comorbidities related to obesity, such as type 2 diabetes mellitus, obstructive sleep apnea syndrome, polycystic ovary syndrome, essential hypertension, hyperlipidemia, and so on.ConclusionsLSG has a definite and effective long-term weight loss effect, which is equal to other common weight loss methods. It has been recognized by more and more patients and clinicians because it has advantages of simple operation, safety, high efficiency and fewer complications. However, therapeutic effects of some comorbidities, such as gastroesophageal reflux disease, are still controversial and need further tobe studied.
A lot of evidence-based medical evidence has shown that laparoscopic Roux-en-Y gastric bypass (LRYGB) is a durable and effective method for obesity and diabetes, and can significantly improve a series of obesity-related metabolic complications. This guideline provides a detailed description of the main operating steps and technical points of the symmetric three-port LRYGB, including posture layout, trocar position selection, liver suspension, gauze exposure, production of small gastric sacs, gastrojejunal anastomosis and production of biliary pancreatic branches, entero-enteric side to side anastomosis, closure of gastrointestinal anastomosis and mesenteric hiatus, greater omentum coverage, and closure of incisions. The purpose is to standardize the operating process of the symmetrical three hole method of LRYGB, providing standardized surgical operation references for clinical doctors in the field of obesity metabolic surgery.
Laparoscopic Roux-en-Y gastric bypass (RYGB) is a classic operation in the field of obesity metabolic surgery. It not only obviously reduces body weight but also exhibits notable therapeutic efficacy in treating metabolic diseases such as type 2 diabetes. However, it can result in complications such as postoperative dumping syndrome and a lack of satiety after meals. So our team has further modified the RYGB, introducing a long and narrow pouch in RYGB (LN-RYGB), its core is reserving the length of the gastric pouch, then the long and narrow pouch could make maintaining a small gastric volume for a prolonged period, make food pass through slowly, and reduce reflux and decrease the incidences of dumping syndrome and intestinal bile acid reflux relevant to RYGB. The gastric contents could be thoroughly mixed, not only leading to a stronger satiety after meals but also reducing risk of postoperative bounce back. Furthermore, ulcer complications relevant to RYGB markedly declined, the therapeutic outcome is better especially in patients with type 2 diabetes. In future, more results and data relevant to LN-RYGB can be accumulated in clinic to further confirm its safety and effectiveness. Mearnwhile, it should still be paid attended to that LN-RYGB still faccs certain difficulties and has a clear indication. At present, the indications of RYGB are served as reference, and postoperative malnutrition and element deficiency need to be prevented and a long-term follow-up is also necessary.
Both bariatric surgery and pharmacotherapy, particularly glucagon-like peptide-1 receptor agonist (GLP-1RA), are effective interventions for obesity, yet each has its own advantages and limitations. Drawing on the “bridging” concept from cancer therapy, this commentary explores an innovative obesity management strategy that involves the combined application of GLP-1RA and bariatric surgery during the perioperative period, with the aim of optimizing treatment outcomes. The present analysis focuses specifically on the potential value of this approach: preoperatively, GLP-1RAs serve as a “bridging therapy” to promote weight loss and reduce surgical risks in severely obese patients; postoperatively, they might be used to manage weight rebound or insufficient weight loss. This multimodal integrated strategy is designed to overcome the inherent limitations of single therapies and offer patients more comprehensive treatment options. Emphasizing that future research must urgently focus on optimizing treatment parameters (e.g., timing, dosage), evaluating long-term safety and efficacy, and establishing patient selection criteria for combination therapy. Integrating surgical and pharmacological treatments, this comprehensive strategy based on the oncological “bridging” concept represents a highly promising paradigm shift in obesity management.