A Multidisciplinary Approach to Medical Weight Loss Prior to Complex Abdominal Wall Reconstruction: Is it Feasible?
A Multidisciplinary Approach to Medical Weight Loss Prior to Complex Abdominal Wall Reconstruction: Is it Feasible?
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复杂腹壁重建之前的多学科医学减肥方法：可行吗？
DOI：
10.1007/s11605-015-2856-6
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发表时间：
2015
影响因子：
3.2
通讯作者：
A. Prabhu
中科院分区：
文献类型：
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作者：
M. Rosen;K. Aydogdu;Kevin T. Grafmiller;C. Petro;G. H. Faiman;A. Prabhu
肥胖是围手术期并发症的主要危险因素，尤其是对于接受复杂的切口式疝修补术的患者。在复杂的腹壁重建之前，医学减肥计划的可行性和有效性还没有得到很好的表征。在这里，我们报告了我们与一位医学减肥专家合作的经验，该专家使用一种改良的蛋白质Sparing FAST，以便在复杂的腹壁重建之前优化减肥。在我们的前瞻性数据库中，我们的医疗减肥专家在复杂的腹股沟修补之前对病态肥胖患者(身体质量指数 >； 35公斤/平方米)进行了评估。我们的主要结果衡量标准是手术干预前的体重减少量。我们的次要结果衡量标准是确定手术干预后长期随访期间体重减轻的维持情况。共有25名体重指数 &> 为35千克/平方米的患者在接受计划的腹股沟修补术之前，由我们的医疗减肥专家进行了评估。术前体重 ± 25(96~205g)，平均128g( ± 标准差)；体重指数 ± 10(36~85)，平均49.0g/m2。术前改良蛋白快速保留完成后，手术组术前体重下降2~80 kg，平均24 ± 21。术前体重指数总体变化为9 kg/m2 ± 8(0.6~33)。术前超重体重指数丢失百分比为37% ± 23(2~83)，总体重指数丢失百分比为18% ± 12(1~43)。在24名手术前在该计划中最初减肥的患者中，22名(88%)在整个研究期间成功地保持了他们的体重减轻，平均为18个月。与医学减肥专家和外科医生合作，使用一种经过修改的蛋白质Sparing FAST的结构化方法，可以在复杂的腹壁重建之前成功地实现有意义的减肥。这项研究中的大多数患者在长期的随访中能够保持他们的体重减轻。利用与医学减肥专家合作修改的FAST蛋白是在选择复杂的外科手术之前指导病态肥胖症患者减肥的宝贵资源。
Obesity is a major risk factor for perioperative morbidity, especially for patients undergoing complex incisional hernia repair. The feasibility and effectiveness of medical weight loss programs prior to complex abdominal wall reconstruction have not been well characterized. Here, we report our experience collaborating with a medical weight loss specialist utilizing a protein sparing modified fast in order to optimize weight loss prior to complex abdominal wall reconstruction. Morbidly obese patients (body mass index (BMI) > 35 kg/m2) evaluated by our medical weight loss specialist prior to complex ventral hernia repair were identified within our prospective database. Our primary outcome measure was the amount of weight lost prior to surgical intervention. Our secondary outcome measure was to determine the maintenance of weight loss during long-term follow-up after the surgical intervention. A total of 25 patients with a BMI > 35 kg/m2 were evaluated by our medical weight loss specialist prior to undergoing a planned incisional hernia repair. The mean weight of the patients preoperatively was 128 kg ± 25 (range 96–205 kg) (mean ± standard deviation), and the mean BMI was 49 kg/m2 ± 10 (range 36–85). After completion of the preoperative modified protein sparing fast, the mean preoperative weight loss of the group was 24 kg ± 21 (range 2–80 kg). The overall change in BMI for the group prior to surgery was 9 kg/m2 ± 8 (0.6 to 33). The percentage of excess BMI loss and total BMI loss preoperatively was 37 % ± 23 (2 to 83) and 18 % ± 12 (1 to 43), respectively. Of the 24 patients that initially lost weight in the program preoperatively, 22 (88 %) successfully maintained their weight loss for the entire study period for an average of 18 months. Collaboration with a medical weight loss specialist and a surgeon with a structured approach using a modified protein sparing fast can successfully result in meaningful weight loss prior to complex abdominal wall reconstruction. The majority of patients in this study were able to maintain their weight loss during long-term follow-up. Utilization of a protein sparing modified fast in collaboration with a medical weight loss specialist is a valuable resource for guiding weight loss in patients with morbid obesity prior to elective complex surgical procedures.