Mason E E, Hesson W W
Department of Surgery, University of Iowa, Iowa City, USA.
Obes Surg. 1998 Aug;8(4):419-28. doi: 10.1381/096089298765554304.
A patient cannot consent to an operation without being adequately informed. There are a number of different operations in use today for treatment of severe obesity. The variations are designed to (1) limit food intake and/or (2) create malabsorption. The surgeon has a duty, according to the law of informed consent, to provide all of the information necessary for a reasonable person to decide whether to consent to the operation recommended. Changes in anatomy, function and risk therefore need to be explained. When only limitation of intake is planned, as in vertical banded gastroplasty (VBG), the patient should know how large the pouch will be and how the outlet will be stabilized. When both intake restriction and malabsorption are planned, as in Roux-en-Y gastric bypass (RGB), or biliopancreatic diversion (BPD), the patient should know whether there will be a larger pouch (less restriction) and a short common channel (more malabsorption) as in BPD or a smaller pouch and less malabsorption. Patients should know that if they have an operation that uses maximum malabsorption to bring weight to a nearly normal level, the risk of malnutrition will be increased, which may require further hospitalization and possible operative treatment. When the duodenum is to be bypassed, the patient should know that this will impair iron and calcium absorption, and that access to this area for radiologic and endoscopic procedures may not be possible. Simple drawings can be used to explain what is planned and how the operation will determine body weight, side-effects, and risk.
患者在未得到充分告知的情况下不能同意进行手术。如今有多种不同的手术用于治疗重度肥胖。这些手术的差异旨在：（1）限制食物摄入量和/或（2）造成吸收不良。根据知情同意法，外科医生有责任提供一个理性的人在决定是否同意所推荐的手术时所需的所有信息。因此，需要解释解剖结构、功能和风险方面的变化。当仅计划限制摄入量时，如在垂直捆绑胃成形术（VBG）中，患者应了解胃囊会有多大以及出口将如何固定。当计划同时限制摄入量和造成吸收不良时，如在Roux-en-Y胃旁路术（RGB）或胆胰转流术（BPD）中，患者应了解是否会像BPD那样有一个较大的胃囊（限制较少）和一个较短的共同通道（吸收不良较多），还是一个较小的胃囊和较少的吸收不良。患者应知道，如果他们接受一种利用最大程度吸收不良使体重接近正常水平的手术，营养不良的风险将会增加，这可能需要进一步住院治疗以及可能的手术治疗。当十二指肠要被绕过的时候，患者应知道这会损害铁和钙的吸收，并且可能无法通过放射学和内镜检查进入该区域。可以使用简单的示意图来解释计划的内容以及手术将如何决定体重、副作用和风险。
