Preoperative weight loss by noninvasive approach in patients with obesity scheduled for bariatric and metabolic surgery: an update narrative review of indications and results available until 2024.

IF 2.4 3区 医学 Q2 SURGERY
Ilenia Grandone, Monica Nannipieri, Caterina Conte, Edda Cava, Luigi Schiavo
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Abstract

Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity and its metabolic complications. Currently, most MBSs are performed laparoscopically. However, high weight associated with an enlarged liver (especially the left lobe liver section, LLLS) may complicate the technical aspects of this surgery. Therefore, before MBS, moderate preoperative weight loss (PreopWL), and reduction in LLLS are desirable. Moreover, studies are inconclusive regarding which is the best approach to apply. This narrative review aimed to describe the current scientific evidence on the effect of a noninvasive approach, such as dietary or pharmacotherapy or space-occupying devices on PreopWL, peri-operative complications, hospital length of stay, and post-operative complications in patients with obesity scheduled for MBS. We conducted a literature search and screening for relevant publications from January 2010 to June 2024. We found that PreopWL before MBS is helpful for both patients and surgeons, as it leads to various benefits, such as a decrease in body weight and LLLS size, a lower risk of intra- and post-operative complications, shorter surgery times, and reduced hospital stays. In this context, concerning dietary approaches, several dietary protocols have been introduced over time, among which very low-calorie diets and very low energy ketogenic therapy are widely prescribed; however, larger randomized-controlled trials (RCTs) with well-defined dietary protocols are necessary to make definitive conclusions. Obesity management medications, such as the lipase inhibitor orlistat, phentermine/topiramate, naltrexone/bupropion, the glucagon-like peptide-1 receptor agonists (GLP-1RAs) liraglutide and semaglutide, and the novel dual glucose dependent insulinotropic peptide (GIP)/GLP-1 receptor agonist tirzepatide, has shown to be effective in promoting PreopWL before MBS; however, larger, well-designed RCTs are needed to establish optimal treatment protocols and assess their true benefits in patients scheduled for MBS. Space-occupying devices such as the swallowable intragastric balloon and hydrogel capsules, represent a promising tools but further research is essential to confirm their role.

计划进行减肥和代谢手术的肥胖患者术前采用无创入路减重:到2024年可获得的适应症和结果的最新叙述综述
代谢和减肥手术(MBS)是治疗严重肥胖及其代谢并发症最有效的方法。目前,大多数mbs是在腹腔镜下进行的。然而,与肝脏肿大(尤其是左叶肝切片,LLLS)相关的高体重可能使该手术的技术方面复杂化。因此,在MBS之前,适度的术前减重(PreopWL)和减少LLLS是可取的。此外,关于哪一种是最好的应用方法,研究尚无定论。这篇叙述性综述旨在描述目前关于无创入路的科学证据,如饮食或药物治疗或占位装置对MBS肥胖患者的PreopWL、围手术期并发症、住院时间和术后并发症的影响。我们对2010年1月至2024年6月的相关出版物进行了文献检索和筛选。我们发现,在MBS之前进行PreopWL对患者和外科医生都有帮助,因为它会带来各种好处,例如体重和LLLS大小的减少,术中和术后并发症的风险降低,手术时间缩短,住院时间缩短。在这种背景下,关于饮食方法,随着时间的推移,几种饮食方案被引入,其中非常低热量的饮食和非常低能量的生酮疗法被广泛使用;然而,需要更大规模的随机对照试验(RCTs)和明确的饮食方案才能得出明确的结论。肥胖管理药物,如脂肪酶抑制剂奥利司他、芬特明/托吡酯、纳曲酮/安非他酮、胰高血糖素样肽-1受体激动剂(GLP-1RAs)利拉鲁肽和半马鲁肽,以及新型双葡萄糖依赖性胰岛素肽(GIP)/GLP-1受体激动剂替西帕肽,已被证明可有效促进MBS前PreopWL;然而,需要更大规模、设计良好的随机对照试验来建立最佳治疗方案,并评估其对MBS患者的真正益处。可吞咽的胃内气囊和水凝胶胶囊等占位设备是一种很有前途的工具,但要证实它们的作用,还需要进一步的研究。
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来源期刊
Updates in Surgery
Updates in Surgery Medicine-Surgery
CiteScore
4.50
自引率
7.70%
发文量
208
期刊介绍: Updates in Surgery (UPIS) has been founded in 2010 as the official journal of the Italian Society of Surgery. It’s an international, English-language, peer-reviewed journal dedicated to the surgical sciences. Its main goal is to offer a valuable update on the most recent developments of those surgical techniques that are rapidly evolving, forcing the community of surgeons to a rigorous debate and a continuous refinement of standards of care. In this respect position papers on the mostly debated surgical approaches and accreditation criteria have been published and are welcome for the future. Beside its focus on general surgery, the journal draws particular attention to cutting edge topics and emerging surgical fields that are publishing in monothematic issues guest edited by well-known experts. Updates in Surgery has been considering various types of papers: editorials, comprehensive reviews, original studies and technical notes related to specific surgical procedures and techniques on liver, colorectal, gastric, pancreatic, robotic and bariatric surgery.
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