Korenkov Michael
Department of Visceral Surgery, University of Mainz, Mainz, Germany.
Contrib Nephrol. 2006;151:243-253. doi: 10.1159/000095334.
BACKGROUND/METHODS: Bariatric surgery today is the only effective therapy for morbid obesity. Commonly performed procedures include adjustable gastric banding (AGB) and vertical banded gastroplasty (VBG); variations of Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion or duodenal switch (BPD) and mixed procedures. All these procedures can be performed by open surgery and more recently by laparoscopy. This review discusses key issues in the surgical management of morbid obesity.
The two most common bariatric procedures performed worldwide are laparoscopic AGB and laparoscopic RYGB. Controversy exists regarding the best surgical procedure. For example, gastric bypass is the procedure of choice in the United States, while most surgeons in Europe and Australia favor gastric banding. Weight loss decreased according to the procedures performed in following decreasing order: BPD, RYGB, VBG, AGB.
Concerning the complications and quality of life there is no single operation for morbid obesity without drawbacks. According the currently opinion are gastric restrictive procedures (AGB, VBG) generally considered safe and quick to perform, but the long-term outcome and quality of life, especially with regard to eating patterns, have been questioned. On the other hand the long-term efficacy of AGB can be improved by the development of new band devices. More complex bariatric procedures, such as RYGB or BPD, have a greater potential for serious perioperative complications but are associated with good long-term outcome in terms of weight loss combined with less dietary restriction.
背景/方法：如今，减肥手术是治疗病态肥胖的唯一有效疗法。常见的手术方式包括可调节胃束带术（AGB）和垂直带状胃成形术（VBG）； Roux - Y胃旁路术（RYGB）的变体、胆胰转流术或十二指肠转位术（BPD）以及联合手术。所有这些手术都可以通过开放手术进行，最近也可通过腹腔镜手术进行。本综述讨论了病态肥胖手术治疗中的关键问题。
全球范围内实施的两种最常见的减肥手术是腹腔镜AGB和腹腔镜RYGB。关于最佳手术方式存在争议。例如，在美国胃旁路术是首选术式，而欧洲和澳大利亚的大多数外科医生更倾向于胃束带术。按实施的手术方式，体重减轻程度依次递减为：BPD、RYGB、VBG、AGB。
关于并发症和生活质量，对于病态肥胖没有一种毫无缺点的单一手术。根据目前的观点，胃限制性手术（AGB、VBG）通常被认为操作安全且迅速，但长期效果和生活质量，尤其是在饮食模式方面，受到了质疑。另一方面，新型束带装置的研发可以提高AGB的长期疗效。更复杂的减肥手术，如RYGB或BPD，围手术期严重并发症的潜在风险更大，但在体重减轻方面具有良好的长期效果，且饮食限制较少。
