New York Hospital Queens, Weil Cornell Medical College, Queens, New York, USA.
Surg Obes Relat Dis. 2011 Jul-Aug;7(4):452-8. doi: 10.1016/j.soard.2010.10.009. Epub 2010 Oct 26.
The safety of laparoscopic bariatric procedures in superobese patients is still debatable.
Using the American College of Surgeons National Surgical Quality Improvement Program's participant-use file, the patients who had undergone laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding for morbid obesity were identified. Several perioperative variables, including 30-day morbidity and mortality, were collected, and the data were compared within each procedure after dividing the patients according to the body mass index: <50 kg/m(2) (morbidly obese group and ≥50 kg/m(2) (superobese group).
A total of 29,323 patients who had undergone laparoscopic bariatric procedures from 2005 to 2008 were identified. Overall, compared with the morbidly obese group, the superobese group had more men (3:2), younger patients, a greater incidence of co-morbidities (e.g., hypertension and dyspnea), a significantly increased length of stay, and a greater rate of 30-day mortality (.26% versus .07%, odds ratio [OR] 4.38, P = .0001). In the gastric bypass group, the superobese group had a significantly greater incidence of postoperative complications, including superficial wound infections (2.45%, OR 1.68, P = .0001), reintubation (.61%, OR 1.97, P = .003), pulmonary embolism (.30%, OR 2.13, P = .032), myocardial infarction (.07%, P = .017), deep vein thrombosis (.49%, OR 2.06, P = .006), septic shock (.44%, OR 1.74, P = .04), and 30-day mortality (.28%, OR 2.26, P = .026). In the laparoscopic adjustable gastric banding group, the superobese group had a significantly greater incidence of postoperative complications, including superficial (1.65%, OR 2.18, P = .0013) and deep (.23%, OR 2.56, P = .035) wound infections, sepsis, septic shock and 30-day mortality (.17%, OR 13.4, P = .0219).
Laparoscopic bariatric procedures in superobese patients have been associated with significantly increased complications, including 30-day mortality, compared with morbidly obese patients. However, overall, the procedures appear to be safe, with low complication and 30-day mortality rates.
腹腔镜减重手术治疗超级肥胖患者的安全性仍存在争议。
利用美国外科医师学会国家手术质量改进计划的参与者使用文件，确定了接受腹腔镜 Roux-en-Y 胃旁路术和腹腔镜可调胃束带术治疗病态肥胖的患者。收集了包括 30 天发病率和死亡率在内的几项围手术期变量，并在根据 BMI 将患者分为<50kg/m²（病态肥胖组）和≥50kg/m²（超级肥胖组）后，对每个手术的患者进行比较。
2005 年至 2008 年间，共确定了 29323 例接受腹腔镜减重手术的患者。总体而言，与病态肥胖组相比，超级肥胖组男性比例更高（3:2），患者更年轻，合并症（如高血压和呼吸困难）发生率更高，住院时间明显延长，30 天死亡率也更高（0.26%比 0.07%，比值比[OR] 4.38，P=0.0001）。在胃旁路组中，超级肥胖组术后并发症发生率显著增加，包括浅表伤口感染（2.45%，OR 1.68，P=0.0001）、再插管（0.61%，OR 1.97，P=0.003）、肺栓塞（0.30%，OR 2.13，P=0.032）、心肌梗死（0.07%，P=0.017）、深静脉血栓形成（0.49%，OR 2.06，P=0.006）、感染性休克（0.44%，OR 1.74，P=0.04）和 30 天死亡率（0.28%，OR 2.26，P=0.026）。在腹腔镜可调胃束带组中，超级肥胖组术后并发症发生率显著增加，包括浅表（1.65%，OR 2.18，P=0.0013）和深部（0.23%，OR 2.56，P=0.035）伤口感染、败血症、感染性休克和 30 天死亡率（0.17%，OR 13.4，P=0.0219）。
与病态肥胖患者相比，腹腔镜减重手术治疗超级肥胖患者与并发症显著增加相关，包括 30 天死亡率。然而，总体而言，这些手术似乎是安全的，并发症和 30 天死亡率都很低。
