Santo Marco Aurelio, Pajecki Denis, Riccioppo Daniel, Cleva Roberto, Kawamoto Flavio, Cecconello Ivan
Metabolic and Bariatric Surgery Unit, Discipline of Digestive Surgery, University of São Paulo Medical School (Unidade de Cirurgia Bariátrica e Metabólica, Disciplina de Cirurgia do Aparelho Digestivo. Faculdade de Medicina da Universidade de São Paulo), São Paulo, SP, Brazil.
Arq Gastroenterol. 2013 Jan-Mar;50(1):50-5. doi: 10.1590/s0004-28032013000100010.
Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control.
The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery) were reviewed. Ninety-three (17.2%) patients were male and 445 (82.8%) were female. The ages of the patients ranged from 18 to 70 years (average = 46), and their body mass indices ranged from 34.6 to 77 kg/m2.
Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5%) patients experienced pulmonary thromboembolism. The mortality rate was 0,55%.
The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years.
减肥手术已被证明是治疗重度肥胖最有效的方法。然而，减肥手术的可接受性仍受到质疑。在治疗重度肥胖的手术后早期观察到的手术并发症与胃肠道其他大型手术相关的并发症相似。然而，鉴于这些患者合并症更频繁出现，在术后早期随访中需要特别关注。这些并发症的早期诊断和适当治疗与更好的控制概率直接相关。
回顾了538例接受手术治疗（Roux-en-Y胃旁路手术）的病态肥胖患者的病历。93例（17.2%）患者为男性，445例（82.8%）为女性。患者年龄在18至70岁之间（平均46岁），体重指数在34.6至77kg/m²之间。
早期并发症发生率为9.6%，分布如下：出血占2.6%，肠梗阻占1.1%，腹腔感染占3.2%，2.2%发生需要住院治疗的腹壁感染。3例（0.5%）患者发生肺血栓栓塞。死亡率为0.55%。
早期并发症发生率较低。这些并发症的诊断大多基于体征和症状进行临床诊断。临床体征和早期治疗的价值，特别是在脓毒症病例中，对良好的手术结果至关重要。死亡率主要与血栓栓塞和65岁以上的高龄有关。
