Información del artículo
Resumen
Con el objetivo de establecer la evidencia científica disponible respecto a la efectividad y la seguridad de las diferentes técnicas de cirugía bariátrica actualmente en uso, hemos analizado las principales bases de datos electrónicas (PubMed, Medline, Cochrane Library, Índice Médico Español, INAHTA) y en particular la revista Obesity Surgery, reteniendo las revisiones sistemáticas, los estudios comparativos aleatorizados, las cohortes, los casos y controles y las series de casos de amplia muestra y período de seguimiento prolongado.
La cirugía, tanto por vía abierta como laparoscópica, obtiene una mayor pérdida de peso que el tratamiento convencional, con mejoría en la calidad de vida y en las comorbilidades. Existe un nivel de evidencia adecuado de que el bypass gástrico resulta superior a la cirugía restrictiva. La seguridad se reduce a medida que aumenta el nivel de complejidad de la técnica empleada. Las derivaciones biliopancreáticas no han sido sometidas a ningún estudio controlado y aleatorizado.
Palabras clave:
Obesidad mórbida
Cirugía de la obesidad
Medicina basada en la evidencia
To identify the scientific evidence available on the safety and effectiveness of the various bariatric surgical techniques currently in use, we analyzed the main electronic databases (PubMed, Medline, Cochrane Library, Índice Médico Español, INAHTA) and particularly the journal Obesity Surgery. Systematic reviews, randomized comparative studies, cohorts, case control studies and case series with large samples and prolonged follow-up were retrieved.
Both open and laparoscopic surgery provides greater weight loss than conventional treatment, improving quality of life and reducing comorbidity. There is a sufficient level of evidence to indicate that gastric bypass is more effective than restrictive surgery. Safety is inversely correlated with greater technical complexity. No controlled, randomized studies of biliopancreatic diversions have been performed.
Key words:
Morbid obesity
Bariatric surgery
Evidencebased medicine
El Texto completo está disponible en PDF
Bibliografía
[1.]
Sociedad Española para el estudio de la obesidad (SEEDO). Consenso SEEDO’2000 para la evaluación del sobrepeso y la obesidad y el establecimiento de criterios de intervención terapéutica.
Med Clin (Barc), 115 (2000), pp. 587-597
[2.]
K.M. Flegal, M.D. Carroll, C.L. Odgen, C.L. Johnson.
Prevalence and trends in obesity among US adults, 1999-2000.
JAMA, 288 (2002), pp. 1723-1727
[3.]
J. Colquitt, A. Clegg, M. Sidhu, P. Royle.
Surgery for morbid obesity (Cochrane Review).
En: The Cochcrane Library, Issue 2,
[4.]
A.J. Clegg, J. Colquitt, M.K. Sidhu, P. Royle, E. Loveman, A. Walker.
The clinical effectiveness and cost-effectiveness of surgery for people with morbid obesity: a systematic review and economic evaluation.
Health Technol Assess, 6 (2002), pp. 1-153
[5.]
J.E. Manson, W.C. Willett, M.J. Stampfer, G.A. Golditz, D.J. Hunter, S.E. Hankinson, et al.
Body weight and mortality among women.
N Engl J Med, 33 (1995), pp. 677-685
[6.]
E.E. Calle, M.J. Thun, J.M. Petrelli, C. Rodríguez, C.W. Heath.
Bodymass index and mortality in a prospective cohort of US adults.
N Engl J Med, 341 (1999), pp. 1097-1105
[7.]
E.J. Drenick, G.S. Bale, F. Seltzer, D.G. Johnson.
Excessive mortality and causes of death in morbidly obese men.
JAMA, 243 (1980), pp. 443-445
[8.]
NIH Conference. Gastrointestinal surgery for severe obesity.
NIH Consensus development conference statement Ann Intern Med, 115 (1991), pp. 956-961
[9.]
D.L. Sackett, W.M. Rosenberg, J.A. Gray, R.B. Haynes, W.S. Richardson.
Evidence-based medicine: what it is and what it isn’t.
BMJ, 312 (1996), pp. 71-72
[10.]
A.J. Jovell, M.D. Navarro-Rubio.
Evaluación de la evidencia científica.
Med Clin (Barc, 105 (1995), pp. 740-743
[11.]
J.D. Urschel, C.H. Goldsmith, V.R. Tandan, J.D. Miller.
for the Evidence- Based Surgery Working Group. Users’ guide to evidence-based surgery: how to use an article evaluating surgical interventions.
Can J Surg, 44 (2001), pp. 95-100
[12.]
P. Gentileschi, S. Kini, M. Catarci, M. Gagner.
Evidence-based medicine: open and laparoscopic bariatric surgery.
Surg Endosc, 16 (2002), pp. 736-744
[13.]
G.H. Guyatt, D.L. Sackett, D.J. Cook.
for the Evidence-Based Medicine Working Group. Users’ guides to the medical literature (II): how to use an article about therapy or prevention A: are the results of the study valid?.
JAMA, 270 (1993), pp. 2598-2601
[14.]
National Institutes of Health, (1998),
[16.]
W.O. Griffen, V.L. Young, C.C. Stevenson.
A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity.
Ann Surg, 186 (1977), pp. 500-509
[17.]
J.P. O’Leary.
Gastrointestinal malabsorptive procedures.
Am J Clin Nutr, 55 (1992), pp. 567S-570S
[18.]
ANAES, (2000),
[19.]
A. Chapman, P. Game, P. O’Brien, G. Maddern, G. Kiroff, B. Foster, et al.
ASERNIP-S, (2002),
[20.]
CETS, (1998),
[21.]
R. Rico Iturrioz, I. Díez del Val, F. Salcedo Fernández, C. Martínez Blázquez, B. Mazagatos Uriarte, J.J. Arrizabalaga Abasolo, et al.
Departamento de Sanidad del Gobierno Vasco, (2003),
[22.]
J.D. Douketis, J.W. Feightner, J. Attia, W.F. Feldman.
with the Canadian Task Force on Preventive Health Care. Periodic health examination, 1999 update: 1. Detection, prevention and treatment of obesity.
CMAJ, 160 (1999), pp. 255-513
[23.]
L. Sjostrom.
Surgical intervention as a strategy for treatment of obesity.
Endocrine, 13 (2000), pp. 213-230
[24.]
T. Andersen, K.H. Stockholm, O.G. Backer, F. Quaade.
Long-term (5- year) results after either horizontal gastroplasty or very-low-calorie diet for morbid obesity.
Int J Obes, 12 (1988), pp. 277-284
[25.]
J. Karlsson, L. Sjostrom, M. Sullivan.
Swedish obese subjects (SOS) –an intervention study of obesity. Two-year follow up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity.
Int J Obes, 22 (1998), pp. 113-126
[26.]
K. Narbro, G. Agren, E. Jonsson, B. Larsson, I. Naslund, H. Wedel, et al.
Sick leave and disability pension before and after treatment for obesity: a report from the Swedish obese Subjects (SOS) study.
Int J Obes, 23 (1999), pp. 619-624
[27.]
A.R. Ashy, A.A. Merdad.
A prospective study comparing vertical banded gastroplasty versus laparoscopic adjustable gastric banding in the treatment of morbid and superobesity.
Int Surg, 83 (1998), pp. 108-110
[28.]
K. Nilsell, A. Thorne, S. Sjostedt, J. Apelman, N. Pettersson.
Prospective randomised comparison of adjustable gastric banding and vertical banded gastroplasty for morbid obesity.
Eur J Surg, 167 (2001), pp. 504-509
[29.]
L.T. De Wit, L. Mathus-Vliegen, C. Hey, B. Rademaker, D.J. Gouma, H. Obertop.
Open versus laparoscopic adjustable silicone gastric banding: a prospective randomized trial for treatment of morbid obesity.
Ann Surg, 230 (1999), pp. 800-805
[30.]
J.S. Azagra, M. Goergen, J. Ansay, P. De Simone, M. Vanhaverbeek, L. Devuyst, et al.
Laparoscopic gastric reduction surgery: preliminary results of a randomized, prospective trial of laparoscopic versus open vertical banded gastroplasty.
Surg Endosc, 13 (1999), pp. 555-558
[31.]
E.J. DeMaria, H.J. Sugerman, J.G. Meador, J.M. Doty, J.M. Kellum, L. Wolfe, et al.
High failure rate after laparoscopic adjustable silicone gastric banding for treatment of morbid obesity.
Ann Surg, 233 (2001), pp. 809-818
[32.]
L. Howard, M. Malone, A. Michalek, J. Carter, S. Alger, J. Van Woert.
Gastric bypass and vertical banded gastroplasty -a prospective randomized comparison and 5-year follow-up.
Obes Surg, 5 (1995), pp. 55-60
[33.]
I. Naslund.
Gastric bypass versus gastroplasty. A prospective study of differences in two surgical procedures for morbid obesity.
Acta Chir Scand, 536 (1987), pp. 1-60
[34.]
H.J. Sugerman, J.V. Starkey, R. Birkenhauer.
A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters.
Ann Surg, 205 (1987), pp. 613-624
[35.]
J.C. Hall, J.M. Watts, P.E. O’Brien, R.E. Dunstan, J.F. Walsh, A.H. Slavotinek, et al.
Gastric surgery for morbid obesity. The Adelaide Study.
Ann Surg, 211 (1990), pp. 419-427
[36.]
L.D. MacLean, B.M. Rhode, J. Sampalis, R.A. Forse.
Results of the surgical treatment of obesity.
Am J Surg, 165 (1993), pp. 155-160
[37.]
R.E. Brolin, H.A. Kenler, J.H. Gorman, R.P. Cody.
Long-limb gastric bypass in the superobese: a prospective randomized study.
Ann Surg, 215 (1992), pp. 387-395
[38.]
P.S. Choban, L. Flancbaum.
The effect of Roux limb lengths on outcome after Roux-en-Y gastric bypass: a prospective, randomized clinical trial.
Obes Surg, 12 (2002), pp. 540-545
[39.]
L.D. MacLean, B.M. Rhode, C.W. Nohr.
Long- or short-limb gastric bypass?.
J Gastrointest Surg, 5 (2001), pp. 525-530
[40.]
R.E. Brolin, L.B. LaMarca, H.A. Kenler, R.P. Cody.
Malabsorptive gastric bypass in patients with superobesity.
J Gastrointest Surg, 6 (2002), pp. 195-205
[41.]
N.T. Nguyen, C. Goldman, C.J. Rosenquist, A. Arango, C.J. Cole, S.J. Lee, et al.
Laparoscopic versus open gastric bypass: a randomised study of outcomes, quality of life and costs.
Ann Surg, 234 (2001), pp. 279-291
[42.]
A. Westling, S. Gustavsson.
Laparoscopic versus open Roux-en-Y gastric bypass: a prospective, randomized trial.
Obes Surg, 11 (2001), pp. 284-292
[43.]
B.M. Balsiger, F.P. Kennedy, H.S. Abu-Lebdeh, M. Collazo-Clavell, M.D. Jensen, T. O’Brien, et al.
Prospective evaluation of Roux-en-Y gastric bypass as primary operation for medically complicated obesity.
Mayo Clin Proc, 75 (2000), pp. 673-680
[44.]
J.F. Capella, R.F. Capella.
An assessment of vertical banded gastroplasty- Roux-en-Y gastric bypass for the treatment of morbid obesity.
Am J Surg, 183 (2002), pp. 117-123
[45.]
M.A.L. Fobi, H. Lee, R. Holness, D.G. Cabinda.
Gastric bypass operation for obesity.
World J Surg, 22 (1998), pp. 925-935
[46.]
K.B. Jones.
Experience with the Roux-en-Y gastric bypass and commentary on current trends.
Obes Surg, 10 (2000), pp. 183-185
[47.]
L.D. MacLean, B.M. Rhode, C.W. Nohr.
Late outcome of isolated gastric bypass.
Ann Surg, 231 (2000), pp. 524-528
[48.]
W.J. Pories, K.G. MacDonald, E.J. Morgan, M.K. Sinha, G.L. Dohm, M.S. Swanson, et al.
Surgical treatment of obesity and its effect on diabetes: 10-y follow-up.
Am J Clin Nutr, 55 (1992), pp. 582S-585S
[49.]
R.B. Reinhold.
Late results of gastric bypass surgery for morbid obesity.
J Am Coll Nutr, 13 (1994), pp. 326-331
[50.]
H.J. Sugerman, J.M. Kellum, K.M. Engle, L. Wolfe, J.V. Starkey, R. Birkenhauer, et al.
Gastric bypass for treating severe obesity.
Am J Clin Nutr, 55 (1992), pp. 560S-566S
[51.]
A.C. Wittgrove, G.W. Clark.
Laparoscopic gastric bypass, Roux-en-Y –500 patients: technique and results, with 3-60 month follow-up.
Obes Surg, 10 (2000), pp. 233-239
[52.]
P.R. Schauer, S. Ikramuddin, W. Gourash, R. Ramanathan, J. Luketich.
Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity.
Ann Surg, 232 (2000), pp. 515-529
[53.]
K.D. Higa, K.B. Boone, T. Ho.
Complications of the laparoscopic Rouxen- Y gastric bypass: 1,040 patients –What have we learned?.
Obes Surg, 10 (2000), pp. 509-513
[54.]
E.J. DeMaria, H.J. Sugerman, J.M. Kellum, J.G. Meador, L.G. Wolfe.
Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity.
Ann Surg, 235 (2002), pp. 640-647
[55.]
N. Scopinaro, G.F. Adami, G.M. Marinari, E. Gianetta, E. Traverso, D. Friedman, et al.
Biliopancreatic diversión.
World J Surg, 22 (1998), pp. 936-946
[56.]
E. Totté, L. Hendrickw, R. Van Hee.
Biliopancreatic diversion for treatment of morbid obesity: experience in 180 consecutive cases.
Obes Surg, 9 (1999), pp. 161-165
[57.]
D.S. Hess, D.W. Hess.
Biliopancreatic diversion with a duodenal switch.
Obes Surg, 8 (1998), pp. 267-282
[58.]
P. Marceau, F.S. Hould, S. Simard, S. Lebel, R.A. Bourque, M. Potvin, et al.
Biliopancreatic diversion with duodenal switch.
World J Surg, 22 (1998), pp. 947-954
[59.]
M.M. Murr, B.M. Balsiger, F.P. Kennedy, J.L. Mai, M.G. Sarr.
Malabsorptive procedures for severe obesity: comparison of pancreaticobiliary bypass and very very long limb Roux-en-Y gastric bypass.
J Gastrointest Surg, 3 (1999), pp. 607-612
[60.]
Osakidetza/Servicio Vasco de Salud. Recomendaciones para la práctica clínica de la cirugía bariátrica. Administración de la Comunidad Autónoma Vasca, 2001
[61.]
ASBS y SAGES. Guidelines for laparoscopic and open surgical treatment of morbid obesity.
Obes Surg, 10 (2000), pp. 378-379
[62.]
K.J. O’Flynn, M. Irving.
On the need for evidence-based surgery.
Evidence-Based Medicine, 4 (1999), pp. 6-8
Copyright © 2003. Asociación Española de Cirujanos
