Papadia Francesco Saverio, Cohen Ricardo Vitor, Di Lorenzo Nicola
University of Genoa, Genoa, Italy.
Center for the Treatment of Obesity and Diabetes, Hospital Alemão Oswaldo Cruz, Sao Paolo, Brazil.
Obes Surg. 2025 May;35(5):1584-1585. doi: 10.1007/s11695-025-07851-3. Epub 2025 Apr 7.
Revisional metabolic and bariatric surgery (MBS) in patients with a body mass index (BMI) below the obesity threshold (> 30 kg/m) presents complex clinical and ethical challenges. Indications for reoperation vary widely, from acute complications like gastric band slippage to chronic metabolic disorders such as persistent hypoglycemia after Roux-en-Y gastric bypass (RYGB). While some revisional procedures, like elongation of the common limb for malabsorption-related complications, are widely accepted, other interventions remain controversial. The introduction of a distinct ICD code could help classify MBS-related complications and support surgical decision-making independent of BMI. Additionally, the role of obesity management medications (OMMs) complicates the landscape, as their discontinuation often leads to weight regain. The prophylactic use of MBS to prevent future weight gain is highly debated and risks expanding surgical indications inappropriately. Establishing clear guidelines for revisional surgery in non-obese patients with complications is crucial to ensure justified and effective interventions.
对体重指数（BMI）低于肥胖阈值（>30kg/m²）的患者进行代谢和减重手术（MBS）翻修手术，会带来复杂的临床和伦理挑战。再次手术的适应症差异很大，从胃束带滑脱等急性并发症到诸如Roux-en-Y胃旁路术（RYGB）后持续性低血糖等慢性代谢紊乱。虽然一些翻修手术，如针对吸收不良相关并发症延长共同肠袢，已被广泛接受，但其他干预措施仍存在争议。引入独特的国际疾病分类（ICD）编码有助于对MBS相关并发症进行分类，并支持独立于BMI的手术决策。此外，肥胖管理药物（OMM）的作用使情况变得复杂，因为停用这些药物往往会导致体重反弹。预防性使用MBS以防止未来体重增加备受争议，且有不适当扩大手术适应症的风险。为有并发症的非肥胖患者制定明确的翻修手术指南，对于确保合理有效的干预措施至关重要。
