Department of Internal Medicine, Catholic University, Rome, Italy; Diabetes and Nutritional Sciences, Hodgkin Building, Guy's Campus, King's College London, London, UK.
Diabetes and Nutritional Sciences, Hodgkin Building, Guy's Campus, King's College London, London, UK; Department of Medicine III, Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Dresden, Germany.
Lancet Diabetes Endocrinol. 2018 Jun;6(6):487-499. doi: 10.1016/S2213-8587(17)30434-5. Epub 2018 Jan 29.
Bariatric surgery has many benefits beyond weight loss, including improved control of glycaemia, blood pressure, and dyslipidaemia; hence, such surgery has been rebranded as metabolic surgery. The operations are, unfortunately, also associated with major surgical and medical complications. The medical complications include gastro-oesophageal reflux disease, malnutrition, and metabolic complications deriving from vitamin and mineral malabsorption. The benefits of surgery can be optimised by implementing specific protocols before and after surgery. In this Review, we discuss the assessment of the risk of major cardiac complications and severe obstructive sleep apnoea before surgery, and the provision of adequate lifelong postsurgery nutritional, vitamin, and mineral supplementation to reduce complications. Additionally, we examine the best antidiabetic medications to reduce the risk of hypoglycaemia after gastric bypass and sleeve gastrectomy, and the strategies to improve weight loss or reduce weight regain. Although optimising clinical pathways is possible to maximise metabolic benefits and reduce the risks of complications and micronutrient deficiencies, evolution of these strategies can further improve the risk-to-benefit ratio of metabolic surgery.
减重手术除了能减轻体重外，还有许多益处，包括改善血糖、血压和血脂异常的控制；因此，此类手术已被重新命名为代谢手术。不幸的是，这些手术也会引起严重的手术和医疗并发症。医疗并发症包括胃食管反流病、营养不良以及维生素和矿物质吸收不良引起的代谢并发症。通过在手术前后实施特定的方案，可以优化手术的益处。在这篇综述中，我们讨论了在手术前评估重大心脏并发症和严重阻塞性睡眠呼吸暂停的风险，并提供充足的终生术后营养、维生素和矿物质补充，以减少并发症。此外，我们还研究了最佳的降糖药物，以降低胃旁路和袖状胃切除术后发生低血糖的风险，并探讨了改善减重或减少体重反弹的策略。虽然优化临床路径可以最大限度地提高代谢益处，并降低并发症和微量营养素缺乏的风险，但这些策略的发展可以进一步提高代谢手术的风险效益比。
