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中华肥胖与代谢病电子杂志 ›› 2023, Vol. 09 ›› Issue (03) : 149 -154. doi: 10.3877/cma.j.issn.2095-9605.2023.03.001

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减重手术后慢性腹痛的原因与对策
高文星, 刘浩, 赵稳, 李丁昌, 陈鹏, 金露佳, 刘先强, 董光龙()   
  1. 100853 北京,中国人民解放军总医院第一医学中心普通外科医学部
  • 收稿日期:2023-03-26 出版日期:2023-08-30
  • 通信作者: 董光龙

Chronic abdominal pain after bariatric surgery: causes and countermeasures

Wenxing Gao, Hao Liu, Wen Zhao, Dingchang Li, Peng Chen, Lujia Jin, Xianqiang Liu, Guanglong Dong()   

  1. Department of General Surgery, the First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
  • Received:2023-03-26 Published:2023-08-30
  • Corresponding author: Guanglong Dong
引用本文:

高文星, 刘浩, 赵稳, 李丁昌, 陈鹏, 金露佳, 刘先强, 董光龙. 减重手术后慢性腹痛的原因与对策[J]. 中华肥胖与代谢病电子杂志, 2023, 09(03): 149-154.

Wenxing Gao, Hao Liu, Wen Zhao, Dingchang Li, Peng Chen, Lujia Jin, Xianqiang Liu, Guanglong Dong. Chronic abdominal pain after bariatric surgery: causes and countermeasures[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2023, 09(03): 149-154.

减重手术已成为治疗肥胖症的常用手段之一,尤其对重度肥胖症及相关代谢性疾病人群,降低体重的同时可以改善多种代谢合并症,大大提高了患者的生活质量。随着减重手术在全球范围内的广泛开展,手术量激增的同时也伴随着各种并发症。慢性腹痛是目前术后常见的并发症之一,近半数患者主诉术后有腹痛经历,严重影响患者的治疗效果和预后。因此,积极采取有效措施,及早的预防和识别慢性腹痛,有利于改善预后、提高患者术后生活质量。本文着重论述减重术后慢性疼痛的危险因素、发病原因、预防及处理措施,总结慢性腹痛的临床处理经验。

Bariatric surgery has become one of the common methods for the treatment of obesity, especially for patients with severe obesity and related metabolic diseases. It can reduce body weight and improve the quality of life of patients with metabolic comorbidities. As bariatric surgery has become widely available worldwide, the surge in surgical volume has come with troubling complications. Chronic abdominal pain is one of the common complications after surgery, and nearly half of the patients complain of abdominal pain after surgery, which seriously affects the treatment effect and prognosis of patients. Therefore, actively taking effective measures to prevent and identify chronic abdominal pain as early as possible is conducive to improving the prognosis and quality of life of patients after surgery. This article focuses on the risk factors, causes, prevention and treatment of chronic abdominal pain after bariatric surgery, and discusses the management experience of chronic abdominal pain.

图1 减重术后慢性腹痛的诊治流程
[1]
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes-5-Year Outcomes [J]. N Engl J Med, 2017, 376(7): 641-651.
[2]
Carlin AM, Zeni TM, English WJ, et al. The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity [J]. Ann Surg, 2013, 257(5): 791-797.
[3]
Chahal-Kummen M, Blom-Høgestøl IK, Eribe I, et al. Abdominal pain and symptoms before and after Roux-en-Y gastric bypass [J]. BJS Open, 2019, 3(3): 317-326.
[4]
Gribsholt SB, Pedersen AM, Svensson E, et al. Prevalence of Self-reported Symptoms After Gastric Bypass Surgery for Obesity [J]. JAMA Surg, 2016, 151(6): 504-511.
[5]
Treede RD, Rief W, Barke A, et al. A classification of chronic pain for ICD-11 [J]. Pain, 2015, 156(6): 1003-1007.
[6]
Saunders J, Ballantyne GH, Belsley S, et al. One-year readmission rates at a high volume bariatric surgery center: laparoscopic adjustable gastric banding, laparoscopic gastric bypass, and vertical banded gastroplasty-Roux-en-Y gastric bypass [J]. Obes Surg, 2008, 18(10): 1233-1240.
[7]
Kumbhari V, Le Roux CW, Cohen RV. Endoscopic Evaluation and Management of Late Complications After Bariatric Surgery: a Narrative Review [J]. Obes Surg, 2021, 31(10): 4624-4633.
[8]
Gormsen J, Burcharth J, Gögenur I, et al. Prevalence and risk factors for chronic abdominal pain after Roux-en-Y gastric bypass surgery: A Cohort Study [J]. Ann Surg, 2021, 273(2): 306-314.
[9]
Haskins IN, Amdur R, Vaziri K. The effect of smoking on bariatric surgical outcomes [J]. Surg Endosc, 2014, 28(11): 3074-80.
[10]
Pierik AS, Coblijn UK, De Raaff C a L, et al. Unexplained abdominal pain in morbidly obese patients after bariatric surgery [J]. Surg Obes Relat Dis, 2017, 13(10): 1743-1751.
[11]
Lee PJ, Delaney P, Keogh J, et al. Catecholamine-o-methyltransferase polymorphisms are associated with postoperative pain intensity [J]. Clin J Pain, 2011, 27(2): 93-101.
[12]
Muller-Lissner S, Bassotti G, Coffin B, et al. Opioid-induced constipation and bowel dysfunction: a clinical guideline [J]. Pain Med, 2017, 18(10): 1837-1863.
[13]
Høgestøl IK, Chahal-Kummen M, Eribe I, et al. Chronic abdominal pain and symptoms 5 years after gastric bypass for morbid obesity [J]. Obes Surg, 2017, 27(6): 1438-1445.
[14]
Burton C. Beyond somatisation: a review of the understanding and treatment of medically unexplained physical symptoms (MUPS) [J]. Br J Gen Pract, 2003, 53(488): 231-239.
[15]
Steenackers N, Vanuytsel T, Augustijns P, et al. Adaptations in gastrointestinal physiology after sleeve gastrectomy and Roux-en-Y gastric bypass [J]. Lancet Gastroenterol Hepatol, 2021, 6(3): 225-237.
[16]
Arasaki CH, Del Grande JC, Yanagita ET, et al. Incidence of regurgitation after the banded gastric bypass [J]. Obes Surg, 2005, 15(10): 1408-1417.
[17]
Rimaitis K, Grauslyte L, Zavackiene A, et al. Diagnosis of HELLP Syndrome: A 10-Year Survey in a Perinatology Centre [J]. Int J Environ Res Public Health, 2019, 16(1): 109.
[18]
Peterli R, Wölnerhanssen BK, Peters T, et al. Improvement in glucose metabolism after bariatric surgery: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy: a prospective randomized trial [J]. Ann Surg. 2009, 250(2): 234-241.
[19]
Kilic A, Arslan NC, Savas MC, et al. Acute pancreatitis developed early after laparoscopic sleeve gastrectomy: could it be the result of mechanical factors? [J]. J Laparoendosc Adv Surg Tech A, 2013, 23(10): 841-846.
[20]
Teitelbaum JE, Sinha P, Micale M, et al. Obesity is related to multiple functional abdominal diseases [J]. J Pediatr, 2009, 154(3): 444-446.
[21]
Suter M, Dorta G, Giusti V, et al. Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients [J]. Obes Surg, 2004, 14(7): 959-66.
[22]
Dolan R D, Baker J, Harer K, et al. Small intestinal bacterial overgrowth: clinical presentation in patients with Roux-en-Y gastric bypass [J]. Obes Surg, 2021, 31(2): 564-569.
[23]
Blom-Hogestol IK, Aasbrenn M, Chahal-Kummen M, et al. Irritable bowel syndrome-like symptoms and health related quality of life two years after Roux-en-Y gastric bypass - a prospective cohort study [J]. BMC Gastroenterol, 2019, 19(1): 204.
[24]
Ahmad A, Kornrich DB, Krasner H, et al. Prevalence of dumping syndrome after laparoscopic sleeve gastrectomy and comparison with laparoscopic Roux-en-Y gastric bypass [J]. Obes Surg, 2019, 29(5): 1506-1513.
[25]
Lautenbach A, Stoll F, Mann O, et al. Long-term improvement of chronic low-grade inflammation after bariatric surgery [J]. Obes Surg, 2021, 31(7): 2913-2920.
[26]
Arora T, Seyfried F, Docherty NG, et al. Microbiota-induced obesity requires farnesoid X receptor [J]. Gut, 2016, 65(3): 437-447.
[27]
Bonfrate L, Wang DQ, Garruti G, et al. Obesity and the risk and prognosis of gallstone disease and pancreatitis [J]. Best Pract Res Clin Gastroenterol, 2014, 28(4): 623-635.
[28]
Haal S, Guman MSS, Boerlage TCC, et al. Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicentre, double-blind, randomised, placebo-controlled superiority trial [J]. Lancet Gastroenterol Hepatol, 2021, 6(12): 993-1001.
[29]
Schafer A, Gehwolf P, Kienzl-Wagner K, et al. Linear or circular: Anastomotic ulcer after gastric bypass surgery [J]. Surg Endosc, 2022, 36(5): 3011-3018.
[30]
Coblijn UK, Lagarde SM, De Castro SM, et al. The influence of prophylactic proton pump inhibitor treatment on the development of symptomatic marginal ulceration in Roux-en-Y gastric bypass patients: a historic cohort study [J]. Surg Obes Relat Dis, 2016, 12(2): 246-52.
[31]
Yeung KTD, Penney N, Ashrafian L, et al. Does sleeve gastrectomy expose the distal esophagus to severe reflux?: a systematic review and meta-analysis [J]. Ann Surg, 2020, 271(2): 257-265.
[32]
Abasbassi M, Pottel H, Deylgat B, et al. Small bowel obstruction after antecolic antegastric laparoscopic Roux-en-Y gastric bypass without division of small bowel mesentery: a single-centre, 7-year review [J]. Obes Surg, 2011, 21(12): 1822-1827.
[33]
Quezada N, Leon F, Jones A, et al. High frequency of internal hernias after Roux-en-Y gastric bypass [J]. Obes Surg, 2015, 25(4): 615-621.
[34]
Scozzari G, Zanini M, Cravero F, et al. High incidence of trocar site hernia after laparoscopic or robotic Roux-en-Y gastric bypass [J]. Surg Endosc, 2014, 28(10): 2890-2898.
[35]
Mala T, Hogestol I. Abdominal pain after Roux-En-Y gastric bypass for morbid obesity [J]. Scand J Surg, 2018, 107(4): 277-284.
[36]
Szigethy E, Knisely M, Drossman D. Opioid misuse in gastroenterology and non-opioid management of abdominal pain [J]. Nat Rev Gastroenterol Hepatol, 2018, 15(3): 168-180.
[37]
Hurley RW, Cohen SP, Williams KA, et al. The analgesic effects of perioperative gabapentin on postoperative pain: a meta-analysis [J]. Reg Anesth Pain Med, 2006, 31(3): 237-247.
[38]
Hornock S, Ellis O, Dilday J, et al. The safety of additional procedures at the time of revisional bariatric surgery [J]. Surg Endosc, 2021, 35(7): 3940-3948.
[39]
Vilallonga R, Beisani M, Sanchez-Cordero S, et al. Abdominal Wall Hernia and Metabolic Bariatric Surgery [J]. J Laparoendosc Adv Surg Tech A, 2020, 30(8): 891-895.
[40]
Leyva-Alvizo A, Arredondo-Saldana G, Leal-Isla-Flores V, et al. Systematic review of management of gallbladder disease in patients undergoing minimally invasive bariatric surgery [J]. Surg Obes Relat Dis, 2020, 16(1): 158-164.
[41]
Golas A, El-Attrache BM, Jorge J, et al. Repair of post-bariatric surgery, recurrent, and de novo hiatal hernias improves bloating, abdominal pain, regurgitation, and food intolerance [J]. Surg Obes Relat Dis, 2021, 17(4): 683-691.
[42]
Mikami D, Needleman B, Narula V, et al. Natural orifice surgery: initial US experience utilizing the StomaphyX device to reduce gastric pouches after Roux-en-Y gastric bypass [J]. Surg Endosc, 2010, 24(1): 223-228.
[43]
Mccarty TR, Kumar N. Revision bariatric procedures and management of complications from bariatric surgery [J]. Dig Dis Sci, 2022, 67(5): 1688-1701.
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