Centre for Obesity Research and Education, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, Victoria, Australia.
Br J Surg. 2015 May;102(6):611-8. doi: 10.1002/bjs.9760. Epub 2015 Feb 18.
There are many controversies related to bariatric surgery. This review explores selected areas.
A combination of randomized clinical trials (RCTs), systematic reviews and expert opinion have been brought together to highlight areas of importance or conflict.
Metabolic surgery is an increasingly preferred term rather than bariatric or obesity surgery. Reporting should be standardized to include appropriate weight measures, valid disease measures and data on loss to follow-up. There are many putative mechanisms of effect of key bariatric procedures, but satiety and early satiation appear central. Weight loss must be durable. Long-term outcome studies (more than 10-year follow-up) show that biliopancreatic diversion is most effective, with 72 per cent excess weight loss (EWL). Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding (LAGB) are equally effective, with 54 per cent EWL. There are no long-term data on vertical sleeve gastrectomy. Type II diabetes is a common and serious disease, usually associated with increased weight. Multiple RCTs have shown that bariatric surgery provides clear benefits over continuing with non-surgical therapies. The earlier the treatment, the more likely and durable will be the remission. Bariatric surgery should be available to all who are obese (body mass index over 30 kg/m(2) ). LAGB, a safe, effective, reversible outpatient procedure, is the author's preferred primary option.
减重手术存在诸多争议。本综述探讨了部分相关问题。
本文综合了随机临床试验（RCT）、系统综述和专家意见，以突出重要或存在争议的领域。
代谢手术是一个比减重或肥胖手术更受欢迎的术语。报告应标准化，包括适当的体重测量、有效的疾病测量以及随访失访数据。关键减重手术存在多种潜在的作用机制，但饱腹感和早期饱腹感似乎是关键。减重必须持久。10 年以上的长期结果研究表明，胆胰分流术效果最好，多余体重减轻率（EWL）为 72%。Roux-en-Y 胃旁路术和腹腔镜可调胃束带术（LAGB）的效果相当，EWL 为 54%。尚无关于垂直袖状胃切除术的长期数据。2 型糖尿病是一种常见且严重的疾病，通常与体重增加有关。多项 RCT 表明，与继续非手术治疗相比，减重手术具有明显的益处。治疗越早，缓解的可能性和持久性越高。所有肥胖症患者（BMI 超过 30kg/m2）都应接受减重手术。LAGB 是一种安全、有效、可逆转的门诊手术，是作者首选的一线治疗方法。
