Obesity surgery: Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES)

Abstract

After the patient's multidisciplinary evaluation, obesity surgery should be considered in adults with a documented BMI greater than or equal to 35 and related comorbidity, or a BMI of at least 40. In addition to standard laboratory testing, chest radiography, electrocardiography, spirometry, and abdominal ultrasonography, the preoperative evaluation of obesity surgery patients also includes upper gastrointestinal endoscopy or radiologic evaluation with a barium meal. Psychiatric consultation and polysomnography can safely be restricted to patients with clinical symptoms on preoperative screening. Adjustable gastric banding (GB), vertical banded gastroplasty (VBG), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) are all effective in the treatment of morbid obesity, but differ in degree of weight loss and range of complications. The choice of procedure therefore should be tailored to the individual situation. There is evidence that a laparoscopic approach is advantageous for LAGB, VBG, and GB (and probably also for BPD). Antibiotic and antithromboembolic prophylaxis should be used routinely. Patients should be seen 3 to 8 times during the first postoperative year, 1 to 4 times during the second year and once or twice a year thereafter. Outcome assessment after surgery should include weight loss and maintainance, nutritional status, comorbidities and quality-of-life.

Prevalence of upper digestive endoscopy and gastric histopathology findings in morbidly obese patients

“…Eradication of the H. pylori as a routine in the preoperative of bariatric surgery is still debated and scarce researches were performed in regards the histology of gastric mucosa (2,7,11,23,25,26,30,33,34,35) . Mong et al (25) studied 272 patients who were candidates to bariatric surgery, in which 33 (12%) showed lesions in the upper digestive tract.…”

Surgical management of acute cholecystitis: results of a 2-year prospective multicenter survey in Belgium

“…stay, early laparoscopic cholecystectomy (LC) has come to be considered the standard treatment of AC [1][2][3]. Although an open approach remains a valid option in complicated cases (e.g., gangrenous cholecystitis, etc.…”

Laparoscopic Surgery in Luminal Gastrointestinal Emergencies—a Review of Current Status

“…All the full text papers were reviewed, and the outcomes have been discussed under the headings of appendicitis, perforated peptic ulcers, colorectal emergencies and small bowel obstruction. As the gall bladder is not the part of the luminal gastrointestinal tract and there is already sufficient level 1 evidence in support of laparoscopic cholecystectomy [6], it was excluded from the review.…”

“…Until recently, colonic resection was considered the gold standard for complicated sigmoid diverticulitis, and laparoscopic lavage was suggested only in selective patients [6]. Laparoscopic lavage was originally described by O'Sullivan et al in 1996 [45], and since then, many studies have supported its role in management of perforated diverticular disease [46].…”

“…Due to the dual benefit of being diagnostic as well as therapeutic, it is deemed as an attractive alternative in emergency surgery [5]. The 2006 consensus statement from the European Association for Endoscopic Surgery (EAES) recommended laparoscopic approach in certain conditions (cholecystitis, appendicitis and perforated peptic ulcer), but found it of less and unclear benefit in others (acute diverticulitis and small bowel obstruction) [6].…”