Aly Ahmad, Mori Krinal
Head Upper GI Surgery, Austin Health, Melbourne, Australia.
Consultant Surgeon, Austin Health, Melbourne, Australia.
Ann Transl Med. 2020 Mar;8(Suppl 1):S6. doi: 10.21037/atm.2020.02.167.
Bariatric surgery in super obese patients presents technical, metabolic and risk related challenges. Moreover, there is concern that weight loss and health outcomes of surgery, including gastric bypass, may be lesser than in non super obese (morbidly obese) patients. This may drive clinicians toward more aggressive forms of surgery at the risk of greater morbidity. This review examines outcomes pertaining to laparoscopic Roux en Y gastric bypass (LRYGB) in the super obese and determines the role of such surgery in the current day. Whilst a minor increase in morbidity and mortality risk exists, weight loss outcomes when measured as percentage total body weight loss are equivalent to non super obese patients. Final BMI is not an appropriate indicator of benefit in such patients and may lead to escalation surgery inappropriately. Surgeons employing the use of LRYGB in the super obese should have adequate training and expertise in the technique and operating upon super obese patients should be avoided during the learning curve phase to minimise morbidity risk.
超级肥胖患者的减肥手术存在技术、代谢和风险相关的挑战。此外，人们担心包括胃旁路手术在内的手术减肥效果和健康结果可能不如非超级肥胖（病态肥胖）患者。这可能会促使临床医生采用更激进的手术方式，从而增加发病风险。本综述研究了超级肥胖患者接受腹腔镜Roux-en-Y胃旁路手术（LRYGB）的结果，并确定了此类手术在当今的作用。虽然发病和死亡风险略有增加，但以总体重减轻百分比衡量的减肥效果与非超级肥胖患者相当。最终的体重指数（BMI）并非此类患者获益的合适指标，可能会导致不恰当地升级手术。在超级肥胖患者中采用LRYGB手术的外科医生应在该技术方面接受充分培训并具备专业知识，在学习曲线阶段应避免为超级肥胖患者进行手术，以将发病风险降至最低。
