Obesity surgery: Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES)

Surgical Endoscopy And Other Interventional Techniques - Tập 19 - Trang 200-221 - 2004

S. Sauerland^1,2, L. Angrisani³, M. Belachew⁴, J. M. Chevallier⁵, F. Favretti⁶, N. Finer⁷, A. Fingerhut⁸, M. Garcia Caballero⁹, J. A. Guisado Macias¹⁰, R. Mittermair¹¹, M. Morino¹², S. Msika¹³, F. Rubino¹⁴, R. Tacchino¹⁵, R. Weiner¹⁶, E. A. M. Neugebauer^1,2

¹Conference Organisers on behalf of the Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.), Veldhoven, The Netherlands

²Biochemical and Experimental Division, Medical Faculty, University of Cologne, Germany

³S. Glovanni Bosco Hospital, University Federico II, Naples, Italy

⁴Service de Chirurgie Universitaire, CHRH, Belgium

⁵Department of Digestive and General Surgery, Hopital Europeen G Pompidou, Paris, France

⁶Obesity Unit, Department of Medical and Surgical Sciences, University of Padova, Vicenza, Italy

⁷Wellcome Clinical Research Facility, Addenbrooke’s Hospital, United Kingdom

⁸Centre Hospitalier de Poissy-Saint Germain, Poissy Cedex, France

⁹Department of Surgery, Malaga University, Spain

¹⁰Mental Health Department, Servicio Extremeno de Salud, Junta de Extremadura, Badajoz, Spain

¹¹Department of General Surgery, University Hospital, Innsbruck, Austria

¹²Chirurgia Generale II, Department of Surgery, University of Turin, Italy

¹³Service de Chirurgie Generale et Digestive, Hopital Louis Mourier, France

¹⁴Department of Surgery, Hopitaux Uiversitaires, France

¹⁵Department of Surgery, Catholic University of Rome, Italy

¹⁶Department of Surgery, Krankenhaus Sachsenhausen, Germany

Tóm tắt

The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectivness and surrounding circumstances of the various types of obesity surgery. A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued. After the patient’s multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.

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