Stroh C, Wilhelm B, Weiner R, Ludwig K, Benedix F, Knoll C, Lippert H, Manger T, Adipositas Kompetenznetz
Klinik für Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera gGmbH, Deutschland.
Abteilung für Allgemeinchirurgie, Hufeland Klinikum Mühlhausen, Deutschland.
Zentralbl Chir. 2016 Feb;141(1):45-52. doi: 10.1055/s-0033-1350792. Epub 2013 Dec 13.
Since January 2005, the situation of metabolic and obesity surgery in Germany has been constantly evaluated by the German Bariatric Surgery Registry (GBSR). Data registration is performed using an internet online database with prospective data collection. All registered data were analysed in cooperation with the Institute of Quality Assurance at the Otto-von-Guericke University Magdeburg.
Data collection includes primary and revision/redo-procedures. A main focus of the current study is the analysis of data regarding the perioperative management, in particular, administration of antibiotics.
Since 2005 a significant increase of primary bariatric procedures has been reported. For evaluation of the antibiotic regimen 12 296 primary operations including 684 balloons (BIB), 2950 gastric bandings (GB), 5115 Roux-en-Y-gastric bypasses (RYGBP), 120 Scopinaro's biliopancreatic diversions (BPD), 164 duodenal switches (DS), 3125 sleeve gastrectomies (SG) and 138 other procedures were analysed. In total 77.3 % of the patients with primary procedures received perioperative antibiotics. Patients without concomitant comorbidities received antibiotics significantly less often compared to those with comorbidities. Wound infection rates were comparable for patients who underwent either gastric banding or sleeve gastrectomy.
Surgery has been accepted step by step as a treatment for morbid obesity and its comorbidities in Germany during the last few years. There is only little experience in the literature regarding antibiotic therapy as well as prophylaxis in bariatric surgery. Based on the results of the current study we recommend rather the selective than the routine use of antibiotics depending on different parameters, e.g., operative time, preoperative BMI and concomitant comorbidities.
自2005年1月起，德国肥胖症手术登记处（GBSR）一直在持续评估德国代谢和肥胖症手术的情况。数据登记通过互联网在线数据库进行前瞻性数据收集。所有登记的数据均与马格德堡奥托 - 冯 - 格里克大学质量保证研究所合作进行分析。
数据收集包括初次手术和翻修/再次手术。本研究的一个主要重点是分析围手术期管理的数据，特别是抗生素的使用情况。
自2005年以来，已报告初次肥胖症手术显著增加。为评估抗生素治疗方案，分析了12296例初次手术，包括684例胃内气球置入术（BIB）、2950例胃束带术（GB）、5115例 Roux-en-Y 胃旁路术（RYGBP）、120例斯科皮纳罗胆胰转流术（BPD）、164例十二指肠转位术（DS）、3125例袖状胃切除术（SG）和138例其他手术。总共77.3%的初次手术患者接受了围手术期抗生素治疗。与有合并症的患者相比，无合并症的患者接受抗生素治疗的频率显著较低。接受胃束带术或袖状胃切除术的患者伤口感染率相当。
在过去几年中，手术在德国已逐步被接受为治疗病态肥胖及其合并症的方法。关于肥胖症手术中抗生素治疗和预防的文献经验很少。基于本研究结果，我们建议根据不同参数，如手术时间、术前体重指数和合并症情况，选择性而非常规使用抗生素。
