Santo Marco Aurelio, Riccioppo Daniel, Pajecki Denis, Cleva Roberto de, Kawamoto Flavio, Cecconello Ivan
Unit of Bariatric and Metabolic Surgery, Gastroenterology Department, Discipline of Gastrointestinal Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP, Brasil.
Clinics (Sao Paulo). 2014;69(12):828-34. doi: 10.6061/clinics/2014(12)07.
The incidence of obesity and particularly super obesity, has increased tremendously. At our institution, super obesity represents 30.1% of all severely obese individuals in the bariatric surgery program. In super obesity, surgical morbidity is higher and the results are worse compared with morbid obesity, independent of the surgical technique. The primary strategy for minimizing complications in these patients is to decrease the body mass index before surgery. Preoperative weight reduction can be achieved by a hypocaloric diet, drug therapy, an intragastric balloon, or hospitalization. The objective of this study was to analyze the results of a period of hospitalization for preoperative weight loss in a group of super-obese patients.
Twenty super-obese patients were submitted to a weight loss program between 2006 and 2010. The mean patient age was 46 years (range 21-59). The mean BMI was 66 kg/m2 (range 51-98) and 12 were women. The average hospital stay was 19.9 weeks and the average weight loss was 19% of the initial weight (7-37%). The average caloric intake was 5 kcal/kg/day. After the weight loss program, the patients underwent gastric bypass surgery.
The statistical analysis revealed that after 14 weeks of treatment (15% loss of initial weight), the weight loss was not significant. All patients had satisfactory surgical recovery and were discharged after an average of 4.6 days.
In super obesity, preoperative weight loss is an important method for reducing surgical risks. Hospitalization and a hypocaloric diet are safe and effective. After 14 weeks, the weight loss rate stabilized, signaling the time of surgical intervention in our study.
肥胖尤其是超级肥胖的发病率已大幅上升。在我们机构，超级肥胖在减肥手术项目中占所有重度肥胖个体的30.1%。在超级肥胖中，手术并发症发生率更高，与病态肥胖相比结果更差，且与手术技术无关。将这些患者并发症降至最低的主要策略是在手术前降低体重指数。术前体重减轻可通过低热量饮食、药物治疗、胃内球囊或住院治疗来实现。本研究的目的是分析一组超级肥胖患者术前住院减肥的效果。
20例超级肥胖患者在2006年至2010年期间接受了减肥计划。患者平均年龄为46岁（范围21 - 59岁）。平均体重指数为66kg/m²（范围51 - 98），其中12例为女性。平均住院时间为19.9周，平均体重减轻为初始体重的19%（7% - 37%）。平均热量摄入为5kcal/kg/天。减肥计划结束后，患者接受了胃旁路手术。
统计分析显示，治疗14周后（初始体重减轻15%），体重减轻不显著。所有患者手术恢复良好，平均4.6天后出院。
在超级肥胖中，术前减肥是降低手术风险的重要方法。住院治疗和低热量饮食安全有效。14周后，体重减轻率稳定，表明在我们的研究中是进行手术干预的时机。
