Department of Emergency, Digestive and Metabolic Minimally Invasive Surgery, Poissy and Saint Germain en Laye Hospitals, Poissy-Ile de France, France.
GastroObesoCenter Institute for Metabolic Optimization, Sao Paulo, Brazil.
World J Emerg Surg. 2022 Sep 27;17(1):51. doi: 10.1186/s13017-022-00452-w.
Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.
A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass.
The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting.
在减重手术后数月或数年后出现急性腹痛的患者可能会在当地急诊单位就诊并接受评估和治疗。由于减重手术技术种类繁多，急诊外科医生必须了解最常施行的减重手术后的主要功能结果和长期手术并发症。这些循证指南旨在提出 WSES 成员与 IFSO 减重经验丰富的外科医生合作的共识立场，重点介绍腹腔镜袖状胃切除术和腹腔镜 Roux-en-Y 胃旁路术患者长期并发症后的减重手术后急性腹痛的管理。
成立了一个由经验丰富的普通外科、急性护理和减重外科医生组成的工作组，按照系统评价和荟萃分析报告的首选报告项目（PRISMA-P）进行系统文献复习，并回答在减重急性腹痛手术管理调查后制定的 PICO 问题。文献检索仅限于腹腔镜袖状胃切除术和腹腔镜 Roux-en-Y 胃旁路术的晚期/长期并发症。
减重手术后的急性腹痛是急诊入院的常见原因。了解袖状胃切除术和 Roux-en-Y 胃旁路术后的最常见晚期/长期并发症（> 4 周手术后）及其解剖结构，可在急诊环境中进行有针对性的管理，获得良好的结果，并降低发病率和死亡率。在急诊环境中管理这组患者时，急诊外科医生、放射科医生、内窥镜医生和麻醉师之间必须密切合作。
