Clinical Practice Guidelines For The Perioperative Nutritional, Metabolic, And Nonsurgical Support Of The Bariatric Surgery Patient2013 Update: Cosponsored By American Association Of Clinical Endocrinologists, The Obesity Society, And American Society For Metabolic & Bariatric Surgery

Abstract

The development of these updated guidelines was commissioned by the AACE, TOS, and ASMBS Board of Directors and adheres to the AACE 2010 protocol for standardized production of clinical practice guidelines (CPG). Each recommendation was re-evaluated and updated based on the evidence and subjective factors per protocol. Examples of expanded topics in this update include: the roles of sleeve gastrectomy, bariatric surgery in patients with type-2 diabetes, bariatric surgery for patients with mild obesity, copper deficiency, informed consent, and behavioral issues. There are 74 recommendations (of which 56 are revised and 2 are new) in this 2013 update, compared with 164 original recommendations in 2008. There are 403 citations, of which 33 (8.2%) are EL 1, 131 (32.5%) are EL 2, 170 (42.2%) are EL 3, and 69 (17.1%) are EL 4. There is a relatively high proportion (40.4%) of strong (EL 1 and 2) studies, compared with only 16.5% in the 2008 AACE- TOS-ASMBS CPG. These updated guidelines reflect recent additions to the evidence base. Bariatric surgery remains a safe and effective intervention for select patients with obesity. A team approach to perioperative care is mandatory with special attention to nutritional and metabolic issues.

Hypovitaminosis D in bariatric surgery: A systematic review of observational studies

“…Therefore, it may be difficult to recommend one vitamin D dose that would be optimal to all, and an individualized approach seem reasonable. Indeed, following malabsorptive and combination procedures, monitoring of 25(OH)D level to assess the response to therapy has been recommended by the Endocrine Society and the American Association of Clinical Endocrinologists (AACE)/The Obesity Society (TOS)/American Society for Metabolic and Bariatric Surgery (ASBMS) guidelines on the perioperative care of patients undergoing bariatric surgery [108,109]. While bi-annual monitoring was recommended by the ES guidelines [108], monitoring at 1, 3, 6 and 12 months was recommended by the AACE/TOS/ASBMS guidelines [109].…”

“…Indeed, following malabsorptive and combination procedures, monitoring of 25(OH)D level to assess the response to therapy has been recommended by the Endocrine Society and the American Association of Clinical Endocrinologists (AACE)/The Obesity Society (TOS)/American Society for Metabolic and Bariatric Surgery (ASBMS) guidelines on the perioperative care of patients undergoing bariatric surgery [108,109]. While bi-annual monitoring was recommended by the ES guidelines [108], monitoring at 1, 3, 6 and 12 months was recommended by the AACE/TOS/ASBMS guidelines [109]. Noteworthy, vitamin D doses as high as 9,000 IU daily have been used following bariatric surgery (Appendix), and similar to doses up to 10,000 IU daily used in the general population, such doses have been shown to be safe [110,111].…”

Recommendations for Diagnosis, Referral for Liver Biopsy, and Treatment of Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis

“…86 Although there was no increase in perioperative complications, the authors noted that the results only apply to well-compensated cirrhotic patients treated in a large referral center. 86 Patients with NAFLD who meet other medical criteria for surgery should be referred for bariatric procedures, 87 but data to support bariatric surgery as a specific treatment for NASH remain limited. 1 A prospective RCT is needed to further investigate the safety and efficacy of this promising intervention.…”

Evolution of biliopancreatic diversion in the treatment of morbid obesity and type 2 diabetes mellitus

“…В течение первых двух лет после операции пациенту особенно необходим биохимический контроль эффективности питания и посещение хирурга каждые 3-6 месяцев [42,43], а через 2 года после шунтирующей операции контроль состояния пациента, включая биохи-мические тесты, осуществляется 1 раз в год при условии отсутствия отдаленных осложнений.…”

“…Диагностика, контроль, лечение Diagnosis, control, treatment на исходную тяжесть основного контингента больных, составляет от 0,1 до 1,2% [42,44,46,47]. Смертность в долгосрочном периоде (10,0±6,3 года наблюде-ния) составляет 6,1%, а совокупная смертность через 30 дней, 90 дней и 1 год составляет 0,2%, 0,3% и 0,5% соответственно [46].…”