Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m2): a Modified Delphi Study

被引：5

作者：

de Leon-Ballesteros, Guillermo Ponce ^{[1
]}

Pouwels, Sjaak ^{[2
,3
,4
]}

Romero-Velez, Gustavo ^{[5
]}

Aminian, Ali ^{[6
]}

Angrisani, Luigi ^{[7
]}

Bhandari, Mohit ^{[8
]}

Brown, Wendy ^{[9
]}

Copaescu, Catalin ^{[10
]}

De Luca, Maurizio ^{[11
]}

Fobi, Mathias ^{[12
]}

Ghanem, Omar M. ^{[13
]}

Hasenberg, Till ^{[14
]}

Herrera, Miguel F. ^{[15
,16
]}

Herrera-Kok, Johnn H. ^{[17
]}

Himpens, Jacques ^{[18
]}

Kow, Lilian ^{[19
]}

Kroh, Matthew ^{[20
]}

Kurian, Marina ^{[21
]}

Musella, Mario ^{[22
]}

Narwaria, Mahendra ^{[23
]}

Noel, Patrick ^{[24
,25
]}

Pantoja, Juan P. ^{[26
]}

Ponce, Jaime ^{[27
]}

Prager, Gerhard ^{[28
]}

Ramos, Almino ^{[29
]}

Ribeiro, Rui ^{[30
]}

Ruiz-Ucar, Elena ^{[31
]}

Salminen, Paulina ^{[32
,33
]}

Shikora, Scott ^{[34
]}

Small, Peter ^{[35
]}

Stier, Christine ^{[36
]}

Taha, Safwan ^{[37
]}

Taskin, Eren Halit ^{[38
]}

Torres, Antonio ^{[39
]}

Vaz, Carlos ^{[40
]}

Vilallonga, Ramon ^{[41
]}

Verboonen, Sergio ^{[42
]}

Zerrweck, Carlos ^{[43
]}

Zundel, Natan ^{[44
]}

Parmar, Chetan ^{[45
,46
,47
]}

机构：

[1] Hosp Angeles Morelia, Dept Surg, Postal 331,Int B-502,Ave Montana Monarca,Montana, Morelia 58350, Michoacan, Mexico

[2] Helios St Elisabeth Hosp, Dept Gen Abdominal Surg & Coloproctol, Helios St, Oberhausen, NRW, Germany

[3] Elisabeth Tweesteden Hosp, Dept Intens Care Med, Tilburg, Netherlands

[4] Witten Herdecke Univ, Fac Hlth, Witten, Germany

[5] Dept Endocrine Surg, Cleveland Clin, Cleveland Hts, OH USA

[6] Cleveland Clin, Bariatr & Metab Inst, Dept Gen Surg, Cleveland, OH USA

[7] Univ Federico II Naples, Dept Publ Hlth, I-80131 Naples, Italy

[8] Mohak Bariatr & Robot Hosp, Indore, India

[9] Monash Univ, Dept Surg, Melbourne, Australia

[10] Ponderas Acad Hosp, Dept Surg, Bucharest, Romania

[11] Rovigo Hosp, Dept Surg, Rovigo, Italy

[12] Fobi Med Consulting, Stone Mt, GA USA

[13] Mayo Clin, Dept Surg, Rochester, MN USA

[14] Helios Univ Hosp Wuppertal, Helios Obes Ctr West, Wuppertal, Germany

[15] Amer British Cowdray Med Ctr Observ, Clin Nutr & Obes, Mexico City, Mexico

[16] Inst Nacl Ciencias Med & Nutr Salvador Zubiran, Dept Surg, Mexico City, DF, Mexico

[17] Univ Hosp Leon, Dept Gen & Digest Surg, Leon, Spain

[18] Delta CHIREC Hosp, Bariatr Surg Unit, Brussels, Belgium

[19] Flinders Med Ctr, Adelaide, Australia

[20] Dept Gen Surg, Cleveland Clin, Cleveland Hts, OH USA

[21] NYU Langone Hlth, New York, NY USA

[22] Univ Naples Federico II, Dept Adv Biomed Sci, Naples, Italy

[23] Asian Bariatr Private Ltd, Ahmadabad, Gujarat, India

[24] Clin Bouchard, ELSAN, Marseille, France

[25] Emirates Specialty Hosp, DHCC, Dubai 505240, U Arab Emirates

[26] Digest Dis Inst, Dept Surg, Cleveland Clin Abu Dhabi, Abu Dhabi, U Arab Emirates

[27] CHI Mem Hosp, Chattanooga, TN USA

[28] Med Univ Vienna, Dept Surg, Vienna, Austria

[29] Gastro Obeso Ctr, Sao Paulo, Brazil

[30] Hosp Lusiadas Amadora, Dept Gen Surg, Amadora, Portugal

[31] Fuenlabrada Univ Hosp, Dept Bariatr & Endocrine Surg, Madrid, Spain

[32] Univ Turku, Dept Surg, Turku, Finland

[33] Turku Univ Hosp, Div Digest Surg & Urol, Turku, Finland

[34] Brigham & Womens Hosp, Dept Surg, Div Gen & Gastrointestinal Surg, Boston, MA USA

[35] South Tyneside & Sunderland NHS Fdn Trust, Directorate Gen Surg, Sunderland, England

[36] Heidelberg Univ, Univ Med Ctr Mannheim, Cent Interdisciplinary Endoscopy, Mannheim, Germany

[37] Bariatr & Metab Surg Ctr, Mediclin Hosp, Airport Rd, Abu Dhabi, U Arab Emirates

[38] Istanbul Univ Cerrahpasa, Dept Surg, Med Fac, Istanbul, Turkiye

[39] Univ Complutense Madrid, Hosp Clin San Carlos, Sch Med, Dept Obstet & Gynaecol,Gynaecol Oncol Unit, Madrid, Spain

[40] Hosp CUF Tejo, Obes & Metab Surg Unit, Lisbon, Portugal

[41] Univ Autonoma Barcelona, Vall Hebron Barcelona Hosp, Dept Surg, Enodcrine Metab & Bariatr Surg Unit, Barcelona, Spain

[42] Obes Goodbye Ctr, Tijuana, Mexico

[43] Amer British Cowdray Med Ctr Santa Fe, Mexico City, Mexico

[44] Univ Buffalo, Dept Surg, Buffalo, NY USA

[45] Whittington Hosp NHS Trust, Dept Surg, London, England

[46] Apollo Hosp Educ & Res Fdn, Hyderabad, India

[47] UCL, London, England

来源：

OBESITY SURGERY | 2024年 / 34卷 / 03期

关键词：

Bariatric surgery; Metabolic surgery; Severe obesity; BMI > 60; Y GASTRIC BYPASS; SUPER-MORBIDLY OBESE; GREATER-THAN-OR-EQUAL-TO-60 KG/M(2); OUTCOMES;

D O I：

10.1007/s11695-023-06990-9

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m(2)). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology.Methods A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of >= 70% of experts' votes was achieved.Results A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations.Conclusion This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population.

引用

页码：790 / 813

页数：24

共 33 条

[1] Outcomes of Roux-en-Y gastric bypass versus sleeve gastrectomy in super-super-obese patients (BMI ≥60 kg/m2): 6-year follow-up at a single university
Arapis, Konstantinos
Macrina, Nicoletta
Kadouch, Diana
Parenti, Lara Ribeiro
Marmuse, Jean Pierrre
Hansel, Boris
[J]. SURGERY FOR OBESITY AND RELATED DISEASES, 2019, 15 (01) : 23 - 33
[2] Does BMI Matter? A 10-Year Single Institutional Experience on 571 Bariatric Surgery Patients With BMI >50 kg/m2
Badaoui, Joseph N.
Maroun, Justin W.
Oyefule, Omobolanle O.
Mandrekar, Jay
McKenzie, Travis J.
Kendrick, Michael L.
Kellogg, Todd A.
Ghanem, Omar M.
[J]. SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES, 2022, 32 (04) : 466 - 471
[3] Surgery in Patients with Super Obesity: Medium-Term Follow-Up Outcomes at a High-Volume Center
Bhandari, Mohit
de Leon-Ballesteros, Guillermo Ponce
Kosta, Susmit
Bhandari, Mahak
Humes, Terrel
Mathur, Winni
Fobi, Mathias
[J]. OBESITY, 2019, 27 (10) : 1591 - 1597
[4] Superobese and super-superobese patients: 2-step laparoscopic duodenal switch
Dapri, Giovanni
Cadiere, Guy Bernard
Himpens, Jacques
[J]. SURGERY FOR OBESITY AND RELATED DISEASES, 2011, 7 (06) : 703 - 708
[5] One-Stage vs Two-Stage Laparoscopic Roux-en-Y Gastric Bypass in Obese Patients with Body Mass Index >55 Kg/m2; 5-YEAR FOLLOW UP
Diaz-Tobarra, Maria
Cassinello Fernandez, Norberto
Jorda Gomez, Pablo
Nebih Nofal, Mohammad
Alfonso Ballester, Raquel
Ortega Serrano, Joaquin
[J]. OBESITY SURGERY, 2017, 27 (04) : 955 - 960
[6] Eisenberg D, 2023, OBES SURG, V33, P3, DOI 10.1007/s11695-022-06332-1
[7] Management of abdominal wall hernias in patients with severe obesity
Ghanem, Omar M.
Orenstein, Sean
Lloyd, S. Julie-Ann
Andalib, Amin
Race, Alice
Burt, Holly Ann
Husain, Farah
Goldblatt, Matthew
Kroh, Matthew
[J]. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2023, 37 (09): : 6619 - 6626
[8] Roux-en-Y Gastric Bypass Vs Sleeve Gastrectomy in Super Obesity: a Systematic Review and Meta-Analysis
Gomes-Rocha, Sofia Raquel
Costa-Pinho, Andre Manuel
Pais-Neto, Carolina Coelho
de Araujo Pereira, Andre
Nogueiro, Jorge Pedro Martins
Carneiro, Silvestre Porfirio Ramos
Santos-Sousa, Hugo Miguel Teixeira Ferraz
Lima-da-Costa, Eduardo Jorge
Bouca-Machado, Raquel
Preto, John Rodrigues
[J]. OBESITY SURGERY, 2022, 32 (01) : 170 - 185
[9] The first survey addressing patients with BMI over 50: a survey of 789 bariatric surgeons
Kermansaravi, Mohammad
Lainas, Panagiotis
Shahmiri, Shahab Shahabi
Yang, Wah
Jazi, Amirhossein Davarpanah
Vilallonga, Ramon
Antozzi, Luciano
Parmar, Chetan
Kassir, Radwan
Chiappetta, Sonja
Zubiaga, Lorea
Vitiello, Antonio
Mahawar, Kamal
Carbajo, Miguel
Musella, Mario
Shikora, Scott
[J]. SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, 2022, 36 (08): : 6170 - 6180
[10] Single- Versus Double-Anastomosis Duodenal Switch: Outcomes Stratified by Preoperative BMI
Lind, Romulo P.
Ghanem, Muhammad
Teixeira, Andre F.
Jawad, Muhammad A.
Osorio, Javier
Lazzara, Claudio
Sobrino, Lucia
Ortiz-Ciruela, David
Ruiz de Gordejuela, Amador Garcia
[J]. OBESITY SURGERY, 2022, 32 (12) : 3869 - 3878

← 1 2 3 4 →

Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI &gt; 60 kg/m2): a Modified Delphi Study

Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m2): a Modified Delphi Study