Sauerland S, Angrisani L, Belachew M, Chevallier J M, Favretti F, Finer N, Fingerhut A, Garcia Caballero M, Guisado Macias J A, Mittermair R, Morino M, Msika S, Rubino F, Tacchino R, Weiner R, Neugebauer E A M
European Association for Endoscopic Surgery, Post Office Box 335, Veldhoven, AH, 5500, The Netherlands.
Surg Endosc. 2005 Feb;19(2):200-21. doi: 10.1007/s00464-004-9194-1. Epub 2004 Dec 2.
The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectiveness and surrounding circumstances of the various types of obesity surgery.
A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued.
After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.
病态肥胖症患病率的不断上升以及腹腔镜手术方法的发展，导致减肥手术数量急剧增加。这些指南旨在明确各类肥胖症手术的相对疗效及相关情况。
一个由普通外科/内镜外科、营养和流行病学领域代表组成的共识小组召开会议，就肥胖症手术的具体问题达成共识。系统检索数据库以获取临床试验结果，从而提出基于证据的建议。经过专家两天的讨论和全体会议讨论后，发布了最终声明。
在对患者进行多学科评估后，对于BMI记录大于或等于35且伴有相关合并症的成年人，或BMI至少为40的成年人，应考虑进行肥胖症手术。除了标准实验室检查、胸部X线摄影、心电图、肺活量测定和腹部超声检查外，肥胖症手术患者的术前评估还包括上消化道内镜检查或钡餐放射学评估。术前筛查有临床症状的患者可安全地进行精神科会诊和多导睡眠图检查。可调节胃束带术（GB）、垂直带状胃成形术（VBG）、Roux-en-Y胃旁路术（RYGB）和胆胰转流术（BPD）在治疗病态肥胖症方面均有效，但在体重减轻程度和并发症范围方面存在差异。因此，手术方式的选择应根据个体情况量身定制。有证据表明，腹腔镜手术方法对腹腔镜可调节胃束带术、垂直带状胃成形术和胃束带术（可能对胆胰转流术也适用）具有优势。应常规使用抗生素和抗血栓栓塞预防措施。术后第一年患者应复诊3至8次，第二年复诊1至4次，此后每年复诊一至两次。手术后的结果评估应包括体重减轻及维持情况、营养状况、合并症和生活质量。
