Buchwald Henry, Williams Stanley E
Department of Surgery, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
Obes Surg. 2004 Oct;14(9):1157-64. doi: 10.1381/0960892042387057.
There is a world epidemic of overweight, obesity, and morbid obesity, encompassing 1.7 billion people. Bariatric surgery today is the only effective therapy for morbid obesity.
E-mail requests for information were sent to the presidents of the national societies of the 31 International Federation for the Surgery of Obesity (IFSO) nations, or national groupings, plus Sweden. Responses were tabulated; calculation of relative prevalence of specific procedures was done by weighted averages.
Responders were 26 of 32 (81%) for the general questions and 24 of 32 (75%) for the question on specific operative percentages. In the year 2002-2003, 146,301 bariatric surgery operations were performed by 2,839 bariatric surgeons; 103,000 of these operations were performed in USA/Canada by 850 surgeons. The earliest start date for bariatric surgery was 1953 in the USA; IFSO was founded in 1995. In the year 2002-2003, 37.15% of operations were open; 62.85% laparoscopic. The 6 most popular procedures by weighted averages were: laparoscopic gastric bypass, 25.67%; laparoscopic adjustable gastric banding, 24.14%; open gastric bypass, 23.07%; laparoscopic long-limb gastric bypass, 8.9%; open long-limb gastric bypass, 7.45%; and open vertical banded gastroplasty, 4.25%. Pooling open and laparoscopic procedures, relative percentages were: gastric bypass, 65.11%; gastric banding, 24.41%; vertical banded gastroplasty, 5.43%; and biliopancreatic diversion/duodenal switch, 4.85%. Categorizing into restrictive/malabsorptive, purely restrictive, and primarily malabsorptive, the relative distribution of procedures was 65.11%, 29.84%, and 4.85%, respectively. The number of countries performing gastric banding was 23 (95%), gastric bypass 21 (88%), vertical banded gastroplasty 19 (79%), and biliopancreatic diversion/duodenal switch 16 (67%). Purely restrictive procedures were performed in 24 (100%) of the countries, restrictive/malabsorptive in 21 (88%), and primarily malabsorptive in 18 (75%).
Bariatric surgery is expanding exponentially to meet the global epidemic of morbid obesity. Operative procedures in bariatric surgery are in flux and specific geographic trends and shifts are evident. Yet, of the patients qualifying for surgery, only about 1% are receiving this therapy--the only effective treatment currently available.
超重、肥胖及病态肥胖已成为全球性流行病，涉及17亿人口。如今，减肥手术是治疗病态肥胖的唯一有效疗法。
通过电子邮件向国际肥胖症外科联合会（IFSO）31个成员国或国家集团以及瑞典的全国性学会主席索取信息。对回复进行列表整理；通过加权平均计算特定手术的相对患病率。
关于一般性问题，32个回复者中有26个（81%）；关于特定手术比例的问题，32个回复者中有24个（75%）。在2002 - 2003年，2839名减肥外科医生共进行了146,301例减肥手术；其中850名外科医生在美国/加拿大进行了103,000例手术。减肥手术最早于1953年在美国开展；IFSO成立于1995年。在2002 - 2003年，37.15%的手术为开腹手术；62.85%为腹腔镜手术。按加权平均计算，6种最常用的手术方法为：腹腔镜胃旁路手术，25.67%；腹腔镜可调节胃束带术，24.14%；开腹胃旁路手术，23.07%；腹腔镜长襻胃旁路手术，8.9%；开腹长襻胃旁路手术，7.45%；开腹垂直束带胃成形术，4.25%。综合开腹和腹腔镜手术，相对比例为：胃旁路手术，65.11%；胃束带术，24.41%；垂直束带胃成形术，5.43%；胆胰分流/十二指肠转位术，4.85%。按限制/吸收不良、单纯限制和主要吸收不良进行分类，手术方法的相对分布分别为65.11%、29.84%和4.85%。进行胃束带术的国家有23个（95%），胃旁路手术的有21个（88%），垂直束带胃成形术的有19个（79%），胆胰分流/十二指肠转位术的有16个（67%）。单纯限制手术在24个（100%）国家开展，限制/吸收不良手术在21个（88%）国家开展，主要吸收不良手术在18个（75%）国家开展。
减肥手术正呈指数级增长，以应对全球性的病态肥胖流行。减肥手术的手术方法不断变化，特定的地理趋势和转变明显。然而，在符合手术条件的患者中，只有约1%接受了这种治疗——这是目前唯一有效的治疗方法。
