Minimally Invasive Surgery Research Center, Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Rasool-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Center of Excellence of European Branch of International Federation for Surgery of Obesity, Hazrat_e Rasool Hospital, Tehran, Iran.
Surg Endosc. 2022 Aug;36(8):6170-6180. doi: 10.1007/s00464-021-08979-w. Epub 2022 Jan 21.
Bariatric surgery in patients with BMI over 50 kg/m is a challenging task. The aim of this study was to address main issues regarding perioperative management of these patients by using a worldwide survey.
An online 48-item questionnaire-based survey on perioperative management of patients with a BMI superior to 50 kg/m was ideated by 15 bariatric surgeons from 9 different countries. The questionnaire was emailed to all members of the International Federation of Surgery for Obesity (IFSO). Responses were collected and analyzed by the authors.
789 bariatric surgeons from 73 countries participated in the survey. Most surgeons (89.9%) believed that metabolic/bariatric surgery (MBS) on patients with BMI over 50 kg/m should only be performed by expert bariatric surgeons. Half of the participants (55.3%) believed that weight loss must be encouraged before surgery and 42.6% of surgeons recommended an excess weight loss of at least 10%. However, only 3.6% of surgeons recommended the insertion of an Intragastric Balloon as bridge therapy before surgery. Sleeve Gastrectomy (SG) was considered the best choice for patients younger than 18 or older than 65 years old. SG and One Anastomosis Gastric Bypass were the most common procedures for individuals between 18 and 65 years. Half of the surgeons believed that a 2-stage approach should be offered to patients with BMI > 50 kg/m, with SG being the first step. Postoperative thromboprophylaxis was recommended for 2 and 4 weeks by 37.8% and 37.7% of participants, respectively.
This survey demonstrated worldwide variations in bariatric surgery practice regarding patients with a BMI superior to 50 kg/m. Careful analysis of these results is useful for identifying several areas for future research and consensus building.
对于 BMI 超过 50kg/m²的患者进行减重手术是一项具有挑战性的任务。本研究旨在通过一项全球性调查，解决此类患者围手术期管理的主要问题。
由来自 9 个国家的 15 位减重外科医生构思了一份基于在线的 48 项问卷调查，内容涉及 BMI 超过 50kg/m²患者的围手术期管理。问卷通过电子邮件发送给国际肥胖外科学会（IFSO）的所有成员。作者对回复进行了收集和分析。
来自 73 个国家的 789 名减重外科医生参与了这项调查。大多数外科医生（89.9%）认为，BMI 超过 50kg/m²的患者应该由减重外科专家进行代谢/减重手术（MBS）。有一半的参与者（55.3%）认为应该在手术前鼓励减重，而 42.6%的外科医生建议至少减轻 10%的超重。然而，只有 3.6%的外科医生建议在手术前使用胃内球囊作为桥接治疗。对于年龄小于 18 岁或大于 65 岁的患者，袖状胃切除术（SG）被认为是最佳选择。对于 18 至 65 岁的患者，SG 和单吻合胃旁路术是最常见的手术方式。有一半的外科医生认为应该为 BMI>50kg/m²的患者提供两阶段治疗方案，SG 是第一步。37.8%和 37.7%的参与者分别建议术后进行 2 周和 4 周的血栓预防治疗。
本调查显示，全球范围内对于 BMI 超过 50kg/m²的患者进行减重手术的实践存在差异。仔细分析这些结果有助于确定未来研究和共识建立的几个领域。
