Kumar Sunjay S, Wunker Claire, Collings Amelia, Bansal Varun, Zoumpou Theofano, Chang Julietta, Rodriguez Noe, Sabour Andrew, Hilton Lisa Renee, Ghanem Omar M, Kushner Bradley S, Loss Lindsey Jean, Aleassa Essa M, Haskins Ivy N, Ayloo Subhashini, Reid Adam, Overby David Wayne, Hallowell Peter, Kindel Tammy Lyn, Slater Bethany J, Palazzo Francesco
Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Surgery, Saint Louis University, St. Louis, MO, USA.
Surg Endosc. 2025 Jan;39(1):1-10. doi: 10.1007/s00464-024-11433-2. Epub 2024 Dec 11.
Patients who are under consideration for or have undergone metabolic and bariatric surgery frequently have comorbid medical conditions that may make their perioperative care more complex. These recommendations address routine intraoperative cholangiography in patients with bypass-type anatomy, the management of reflux disease after sleeve gastrectomy, and the optimal bariatric procedure for patients with comorbid inflammatory bowel disease.
A systematic review was conducted including studies published from 1990 to 2022 to address these questions. These results were then presented to a panel of bariatric surgeons who formulated recommendations based on the best available evidence or utilized expert opinion when the evidence base was lacking.
Conditional recommendations were made in favor of routine intraoperative cholangiography in patients with bypass-type anatomy undergoing laparoscopic cholecystectomy, trialing medical management prior to surgical management in patients with reflux after sleeve gastrectomy, and sleeve gastrectomy rather than Roux en Y gastric bypass in patients with inflammatory bowel disease. The strength of these recommendations was limited by the quality of evidence available. Recommendations for future research were made for all questions.
These recommendations should provide guidance regarding management of these comorbidities in patients who are under consideration for or have undergone metabolic and bariatric surgery. These recommendations also identify important areas where the future research should focus to strengthen the evidence base.
正在考虑接受或已经接受代谢和减重手术的患者常常合并有其他疾病，这可能会使他们的围手术期护理更加复杂。这些建议涉及具有旁路型解剖结构患者的常规术中胆管造影、袖状胃切除术后反流性疾病的管理，以及合并炎症性肠病患者的最佳减重手术方式。
进行了一项系统评价，纳入了1990年至2022年发表的研究以解决这些问题。然后将这些结果提交给一组减重外科医生，他们根据现有最佳证据制定建议，在缺乏证据基础时则采用专家意见。
提出了有条件的建议，支持对接受腹腔镜胆囊切除术的旁路型解剖结构患者进行常规术中胆管造影；对于袖状胃切除术后出现反流的患者，在手术治疗前先试行药物治疗；对于炎症性肠病患者，建议行袖状胃切除术而非 Roux-en-Y 胃旁路术。这些建议的力度受到现有证据质量的限制。针对所有问题都提出了未来研究的建议。
这些建议应为正在考虑接受或已经接受代谢和减重手术的患者中这些合并症的管理提供指导。这些建议还确定了未来研究应重点关注以加强证据基础的重要领域。
