Author/Editor		Miller, Karl
Title		Laparoscopic bariatric surgery in the treatment of morbid obesity
Translated title		Laparoskopska bariatrična kirurgija pri zdravljenju čezmerne debelosti
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 10, št. 24
Publication year		2005
Volume		str. 73-88
Language		eng
Abstract		Long-term studies have shown conservative methods to be ineffective in the treatment of morbid obesity. Surgical approaches are divided into restrictive, malabsorptive, combined restrictive and malabsorptive and motility-reducing procedures. Laparoscopic implantation of an adjustable gastric band is an efficient restrictive measure for treating the majority of patients with this condition. The adjustable gastric band enables weight loss and food intake to be adjusted to the individual patients needs. Eighty to ninety percent of these patients can expect to lose 55%-70% of their excess weight. Vertical banded gastroplasty is losing ground among the restrictive options. Preliminary experience with this technique is encouraging but the long-term results are disappointing when assessed by the standard criteria. Gastric bypass is gaining ground in Europe and has been established as a standard procedure in USA. This operation is estimated to provide 70%-80% excess weight loss and to afford better quality of life than restrictive procedures. The biliopancreatic diversion with a duodenal switch combines a sleeve gastrectomy with a duodenoileal switch to achieve maximum weight loss. Consistent excess weight loss between 70% and 80% is achieved with acceptable decreased longterm nutritional complications. The laparoscopic approach is a surgical technique with optimum benefit and minimal morbidity, especially in super obese patients. Intra-gastric stimulation is the least invasive surgical procedure available. However, it provides lowest excess weight loss in 32% in the first two years after the operation. Provided safety recommendations are observed, laparoscopic operations for obesity have a fairly low risk. The martality rate in centres with experienced staff is less than 0.3%. Currently, surgery offers the only viable treatment option with long-term weight loss and maintenance for the morbidly obese. (Abstract truncated at 2000 characters)
Summary		Konzervativno zdravljenje čezmerne debelosti se je v dolgoročnih študijah izkazalo kot slabo uspešno. Kirurško zdravljenje lahko razdelimo na restriktivne, malabsorbcijske, kombinirane restriktivno-malabsorbcijske metode in metode, ki zmanjšujejo motiliteto prebavnega trakta. Laparoskopska vstavitev nastavljive želodčne preveze (gastric banding) je uspešna restriktivna metoda za zdravljenje čezmerne debelosti. Nastavljiva želodčna preveza omogoča individualno prilagajanje izgube telesne teže in vnosa hrane skladno z bolnikovimi potrebami. Zmanjšanje čezmerne telesne teže za 55 - 70% lahko pričakujemo pri 90% teh bolnikov. Vertikalno bandažirana gastroplastika izgublja svoj pomen glede na restriktivne metode. Pueliminarne izkušnje so bile, ohrabrujoče, dolgoročni uspehi, ocenjevani po standardnih merilnih, pa so bili slabi. Obvodne operacije (gastric bypass) pndobivajo svoj pomen pri zdravljenju čezmerne debelosti v Evropi, medtem ko so v ZDA že standardno zdravljenje. Pri tej operaciji pričakujemo zmanjšanje čezmerne telesne teže za 70 do 80%, ob tem pa boljšo kakovost življenja teh bolnikov kot pri restriktivnih metodah. Zman-jšanje čezmenne teže za 70 do 80% se pri tej metodi doseže, ob tem pa so prisotne tudi sprejemljivi manjši nutricionistični zapleti. Laparoskopski pristop pri omenjeni operativni metodi se je izkazal za zelo uspešnega z optimalnimi rezultati zdravljenja in minimalnimi zapleti, še zlasti pri skrajno debelih bolnikih. Intragastrična stimulacija je najnovejša invazivna kirurška metoda, vendar je izguba čezmerne teže s to metodo najmanjša in znaša le 32% v prvih dveh letih po operaciji. (Izvleček skrajšan na 2000 znakov)
Descriptors		OBESITY, MORBID BODY MASS INDEX GASTRIC BYPASS GASTRECTOMY GASTROPLASTY WEIGHT LOSS