Department of Endocrinology, Metabolic Diseases and Nutrition, Toulouse University Hospital.
University of Toulouse, UMR1048, Paul Sabatier University.
Curr Opin Clin Nutr Metab Care. 2018 Sep;21(5):388-393. doi: 10.1097/MCO.0000000000000490.
Bariatric surgery is an effective treatment for classes II and III obesity and its associated diseases. However, many important long-term outcomes of bariatric surgery are still poorly understood, such as neurological and psychological complications, bone health, and so on. This review summarizes the current evidence and expert opinions on nutritional care in the long-term postoperative period.
In the first section, we will provide an update of the main long-term complications: risk of anaemia, risk of bone fracture, neurological and psychological complications, and risk of developing Barrett's oesophagus after sleeve gastrectomy. We will also examine the current strategies used to increase weight loss or reduce weight regain. As adherence to long-term follow-up has been shown to decrease over time, the second section aims to identify all measures that improve follow-up rates, to get the maximum benefit from bariatric surgery, while minimizing long-term adverse effects and complications.
There is still a significant level of uncertainty regarding the best clinical practices for maintaining the health benefits provided by bariatric surgery. The role of family physician in postsurgery care needs to be clearly defined. More effort is needed to improve psychological care, behaviour management, and therapeutic patient education after bariatric surgery. A more patient-centred approach should probably be considered.
减重手术是治疗 II 类和 III 类肥胖及其相关疾病的有效方法。然而，减重手术的许多重要长期结果仍不明确，如神经和心理并发症、骨骼健康等。本综述总结了长期术后营养护理的现有证据和专家意见。
在第一部分，我们将提供主要长期并发症的最新信息：贫血风险、骨折风险、神经和心理并发症，以及袖状胃切除术后发生巴雷特食管的风险。我们还将探讨目前用于增加减重效果或减少体重反弹的策略。由于长期随访的依从性随着时间的推移而下降，第二部分的目的是确定所有提高随访率的措施，以从减重手术中获得最大获益，同时最大限度地减少长期不良影响和并发症。
维持减重手术带来的健康益处的最佳临床实践仍存在很大程度的不确定性。家庭医生在术后护理中的作用需要明确界定。需要加大努力改善减重手术后的心理护理、行为管理和治疗性患者教育。可能需要考虑更以患者为中心的方法。
