Department of General Surgery, Division of Bariatric & Metabolic Surgery, First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu.
Department of General Surgery, Division of Bariatric and Metabolic Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong.
Int J Surg. 2024 May 1;110(5):2577-2582. doi: 10.1097/JS9.0000000000001108.
Performing bariatric surgery on patients with a BMI of over 50 kg/m 2 is challenging. This study aimed to explore the status and challenges related to the perioperative management of such patients in China.
A prospective survey was designed to investigate the perioperative management of patients with a BMI of greater than or equal to 50 kg/m 2 undergoing bariatric surgery in China. The questionnaire of our survey included general information, preoperative management measures, surgical procedures performed, technical details regarding anaesthesia, and postoperative management measures. A response from only one attending physician per bariatric centre was accepted.
Physicians from a total of 101 hospitals responded to the questionnaire, and the questionnaire data from 98 hospitals were complete. These centres had completed a total of 44 702 bariatric surgeries since the launch of such surgery to December 2021. A total of 3280 patients had a BMI exceeding 50 kg/m 2 . The preferred surgical procedures for patients with super obesity were sleeve gastrectomy by 62 centres, Roux-en-Y gastric bypass by 11 centres, sleeve gastrectomy plus jejunojejunal bypass by 19 centres, one anastomosis gastric bypass by 1 centre, and duodenal switch by 1 centre. The most worrying issues were cardiopulmonary failure and difficulty in extubation. 91 centres believed that preoperative weight loss was beneficial. A low-calorie diet was the specific measure mainly implemented, only three centres considered using intragastric balloon placement. Postoperative management measures varied greatly.
Bariatric surgery has seen rapid development. Chinese physicians show significant differences regarding the perioperative management for patients with a BMI of over 50 kg/m 2 . The perioperative risks of these patients remain relatively high, making further development of clinical pathways is necessary.
为 BMI 超过 50kg/m²的患者施行减重手术极具挑战性。本研究旨在探讨中国此类患者围手术期管理的现状和相关挑战。
设计了一项前瞻性调查，以研究中国 BMI 大于或等于 50kg/m²的减重手术患者的围手术期管理。我们的调查问卷包括一般信息、术前管理措施、施行的手术程序、麻醉的技术细节以及术后管理措施。每个减重中心仅接受一位主治医生的回复。
共有 101 家医院的医生回复了问卷，其中 98 家医院的问卷数据完整。自该手术开展至 2021 年 12 月，这些中心共完成了 44702 例减重手术。共有 3280 名患者 BMI 超过 50kg/m²。对于超级肥胖患者，62 家中心首选袖状胃切除术，11 家中心首选 Roux-en-Y 胃旁路术，19 家中心首选袖状胃切除术加空肠空肠旁路术，1 家中心首选单吻合口胃旁路术，1 家中心首选十二指肠转位术。最令人担忧的问题是心肺衰竭和拔管困难。91 家中心认为术前减重有益。低热量饮食是主要实施的具体措施，只有 3 家中心考虑使用胃内球囊放置。术后管理措施差异很大。
减重手术发展迅速。中国医生在 BMI 超过 50kg/m²的患者围手术期管理方面存在显著差异。这些患者的围手术期风险仍然相对较高，有必要进一步制定临床路径。
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