Department of Surgery, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan.
Department of Neuropsychiatry, Toho University Sakura Medical Center, 564-1 Shimoshizu Sakura, Chiba, 285-8741, Japan.
Obes Surg. 2023 May;33(5):1327-1332. doi: 10.1007/s11695-023-06543-0. Epub 2023 Mar 21.
Owing to their difficulty following clinical advice for procedural safety and ideal surgical outcomes, bariatric and metabolic surgery (BMS) for patients with disorders of intellectual development (DID) is concerning. Studies reporting the feasibility of BMS for this population remain scarce. This study aims to clarify the feasibility of laparoscopic sleeve gastrectomy (LSG) for patients with clinically severe obesity and DID.
A retrospective analysis of a single institutional prospective database collected from 2010 to 2022 was performed. The Wechsler Adult Intelligence Scale (WAIS) was used to measure intellectual ability before LSG. A multidisciplinary team approach was implemented to give special support and care to patients with DID. Patients were categorized into groups according to their WAIS scores. LSG outcomes were statistically compared between the DID and average intellectual ability groups.
Using the WAIS to measure intellectual ability among patients who underwent LSG, we identified 14 patients with DID (IQ score: < 69, mean IQ: 63.4) and 71 with average intellectual ability (IQ score: 90-109, mean IQ: 98.9). Operative outcomes were comparable between the groups as follows: operation time (DID: 163 ± 41 min, average intelligence: 162 ± 30 min), hospital stay (DID: 4 [4-5] days, average intelligence: 5 [4-6] days), and total comorbidities (DID: 7.1%, average intelligence: 8.4%). No reoperations were performed, and no mortalities were observed.
With medical and social support and care, performing LSG on patients with clinically severe obesity and DID is safe, with good short-term results.
由于患者智力发育障碍（DID），难以遵循临床建议以确保手术安全和达到理想的手术效果，因此，为患有 DID 的肥胖症患者施行减重和代谢手术（BMS）令人担忧。目前，报道此类人群施行 BMS 可行性的研究仍然较少。本研究旨在阐明为患有临床严重肥胖症和 DID 的患者施行腹腔镜袖状胃切除术（LSG）的可行性。
对 2010 年至 2022 年收集的单一机构前瞻性数据库进行回顾性分析。LSG 前使用韦氏成人智力量表（WAIS）测量智力能力。采用多学科团队方法为 DID 患者提供特殊支持和护理。根据 WAIS 评分将患者分为两组。比较 DID 组和平均智力组的 LSG 结果。
使用 WAIS 测量接受 LSG 的患者的智力能力，我们确定了 14 名患有 DID（智商：<69，平均智商：63.4）和 71 名智力正常的患者（智商：90-109，平均智商：98.9）。两组患者的手术结果相当，如下所示：手术时间（DID：163±41 分钟，平均智力：162±30 分钟）、住院时间（DID：4[4-5]天，平均智力：5[4-6]天）和总合并症（DID：7.1%，平均智力：8.4%）。未行再次手术，也未观察到死亡病例。
在医疗和社会支持和护理的情况下，为患有临床严重肥胖症和 DID 的患者施行 LSG 是安全的，短期结果良好。
