Glatt Dennis, Sorenson Tracy
Sanford Surgical Associates, Sioux Fall, SD, USA.
S D Med. 2011;Spec No:57-62.
The obesity epidemic in the United States is plaguing both the adult and pediatric population. As BMI increases, life expectancy drops. Metabolic and bariatric surgery can be an effective option for morbidly obese patients to enable substantial, sustained weight loss and result in improvement or resolution of comorbidities. The National Institutes of Health's criteria for bariatric surgery includes patients with a BMI of 35 and associated comorbidities, or a BMI of 40 and have failed conservative management. Currently, the common surgeries done in the United States are the laparoscopic Roux-en-Y gastric bypass, the laparoscopic adjustable gastric band, the biliopancreatic diversion with duodenal switch and the sleeve gastrectomy. Complications of the surgery are related either to the stapling, origin of the surgery or the implantable device. Optimal outcomes for patients are achieved with a Center of Excellence designated surgeon and designated facility, demonstrated operative skill, quality outcomes, multidisciplinary support, minimal complications and number of procedures completed. Insurance companies have seen the benefit of covering metabolic and bariatric surgery with comorbidity reduction and reduced health care costs. A multidisciplinary approach to postoperative care includes a dietician, exercise physiologist, psychologist and bariatric nurse coordinator as part of the bariatric surgery team. Metabolic and bariatric surgery pared with healthy food choices and regular exercise is imperative to achieve the desired goal of long-term weight loss and comorbidity resolution.
美国的肥胖流行正困扰着成人和儿童群体。随着体重指数（BMI）的增加，预期寿命会下降。代谢和减重手术对于病态肥胖患者而言可能是一种有效的选择，能够实现显著且持续的体重减轻，并改善或解决合并症。美国国立卫生研究院关于减重手术的标准包括BMI为35且伴有合并症的患者，或BMI为40且保守治疗失败的患者。目前，美国常见的手术方式有腹腔镜Roux-en-Y胃旁路术、腹腔镜可调节胃束带术、胆胰转流十二指肠转位术和袖状胃切除术。手术并发症与吻合器使用、手术起源或植入装置有关。由卓越中心指定的外科医生和指定机构、精湛的手术技能、良好的手术效果、多学科支持、最少的并发症以及完成的手术数量，能够为患者带来最佳预后。保险公司已认识到承保代谢和减重手术在降低合并症以及减少医疗保健成本方面的益处。术后护理的多学科方法包括营养师、运动生理学家、心理学家和减重护理协调员作为减重手术团队的一部分。代谢和减重手术与健康的食物选择及规律运动相结合，对于实现长期体重减轻和合并症解决的预期目标至关重要。
