Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Center for Advanced Methods Development, RTI International, NC, USA.
Obes Rev. 2018 Apr;19(4):529-537. doi: 10.1111/obr.12647. Epub 2017 Dec 20.
The effectiveness of bariatric surgery has been well-studied. However, complications after bariatric surgery have been understudied. This review assesses <30-d major complications associated with bariatric procedures, including anastomotic leak, myocardial infarction and pulmonary embolism. This review included 71 studies conducted in the USA between 2003 and 2014 and 107,874 patients undergoing either gastric bypass, adjustable gastric banding or sleeve gastrectomy, with mean age of 44 years and pre-surgery body mass index of 46.5 kg m . Less than 30-d anastomotic leak rate was 1.15%; myocardial infarction rate was 0.37%; pulmonary embolism rate was 1.17%. Among all patients, mortality rate following anastomotic leak, myocardial infarction and pulmonary embolism was 0.12%, 0.37% and 0.18%, respectively. Among surgical procedures, <30-d after surgery, sleeve gastrectomy (1.21% [95% confidence interval, 0.23-2.19%]) had higher anastomotic leak rate than gastric bypass (1.14% [95% confidence interval, 0.84-1.43%]); gastric bypass had higher rates of myocardial infarction and pulmonary embolism than adjustable gastric banding or sleeve gastrectomy. During the review, we found that the quality of complication reporting is lower than the reporting of other outcomes. In summary, <30-d rates of the three major complications after either one of the procedures range from 0% to 1.55%. Mortality following these complications ranges from 0% to 0.64%. Future studies reporting complications after bariatric surgery should improve their reporting quality.
减重手术的效果已经得到了充分的研究。然而，减重手术后的并发症研究却相对较少。本综述评估了与减重手术相关的 <30 天主要并发症，包括吻合口漏、心肌梗死和肺栓塞。本综述纳入了 2003 年至 2014 年间在美国进行的 71 项研究，共有 107874 例患者接受胃旁路术、可调胃束带术或袖状胃切除术，平均年龄为 44 岁，术前体重指数为 46.5kg/m²。<30 天吻合口漏发生率为 1.15%；心肌梗死发生率为 0.37%；肺栓塞发生率为 1.17%。所有患者中，吻合口漏、心肌梗死和肺栓塞的死亡率分别为 0.12%、0.37%和 0.18%。在所有手术中，袖状胃切除术（1.21%[95%置信区间，0.84-1.43%]）在术后 <30 天的吻合口漏发生率高于胃旁路术（1.14%[95%置信区间，0.84-1.43%]）；胃旁路术的心肌梗死和肺栓塞发生率高于可调胃束带术或袖状胃切除术。在综述过程中，我们发现并发症报告的质量低于其他结果的报告质量。总之，三种主要并发症在任何一种手术之后的 <30 天发生率范围为 0%至 1.55%。这些并发症的死亡率范围为 0%至 0.64%。未来报告减重手术后并发症的研究应提高其报告质量。
