Department of Endocrinology-Nutrition, Ambroise Paré Hospital, AP-HP, EA4340 Research Unit, University Paris-Saclay, 92100, Boulogne-Billancourt, France.
Clinical Research Unit, AP-HP, Paris-Saclay, Hôpital Ambroise Pare, Boulogne-Billancourt, France.
Obes Surg. 2021 Nov;31(11):4767-4775. doi: 10.1007/s11695-021-05623-3. Epub 2021 Sep 7.
Bariatric surgery is associated with significant weight loss and improvement in comorbid conditions but in rare cases can expose to complications requiring intensive nutritional care (INC). INC in this context is poorly described and no data are available concerning long-term impact.
We retrospectively reviewed charts of bariatric patients who were hospitalized in our institution between 2013 and 2018. We identified patients with a postoperative complication requiring INC and we described their nutritional management (INC group). These patients were compared with controls matched to age, gender, preoperative BMI, and type of surgery selected from our database (control group). The primary endpoint was the percentage of total weight loss (%TWL) at 2.5 years. Secondary endpoints were improvement of co-morbidities, vitamin deficiencies, and depression/anxiety scores.
The INC group consisted of 18 patients among which 77.8% had sleeve gastrectomy (SG). Half of these patients underwent revisional surgery. The most common complication was fistula formation (66.7%). Patients in the INC group, compared to the control group, showed a significantly higher %TWL at 2.5 years (33.6% vs 26.1%, P = 0.03). There was no significant difference in either reduction of preoperative comorbidities or depression/anxiety scores between the two groups. The number of patients with more than three nutritional deficiencies was similar in both groups. Thiamine deficiency was only observed in the INC group.
Complications requiring INC after bariatric surgery occur mainly after revisional surgery and may increase long-term %TWL but have no impact on nutritional deficiencies or symptoms of anxiety/depression.
减重手术可显著减轻体重并改善合并症，但在极少数情况下，可能会出现需要重症营养治疗（INC）的并发症。目前对此类并发症的描述较少，且尚无长期影响的数据。
我们回顾性分析了 2013 年至 2018 年在我院住院的减重手术患者的病历。我们确定了术后需要 INC 的并发症患者，并描述了他们的营养管理（INC 组）。将这些患者与从数据库中选择的年龄、性别、术前 BMI 和手术类型相匹配的对照组进行比较（对照组）。主要终点是 2.5 年时的总体重减轻百分比（%TWL）。次要终点是合并症、维生素缺乏和抑郁/焦虑评分的改善。
INC 组包括 18 例患者，其中 77.8%行袖状胃切除术（SG）。其中一半患者接受了翻修手术。最常见的并发症是瘘管形成（66.7%）。与对照组相比，INC 组患者在 2.5 年时的 %TWL 明显更高（33.6% vs 26.1%，P=0.03）。两组患者术前合并症的减少或抑郁/焦虑评分均无显著差异。两组中需要 3 种以上营养缺乏的患者数量相似。仅在 INC 组观察到硫胺素缺乏。
减重手术后需要 INC 的并发症主要发生在翻修手术后，可能会增加长期的 %TWL，但对营养缺乏或焦虑/抑郁症状没有影响。
