Résumé
L’obésité est un problème de santé publique, une épidémie en Europe et aux États-Unis avec une incidence ne cessant de croître au cours de ces dernières années. La chirurgie bariatrique est le dernier recours pour ces patients avec une obésité morbide en association aux traitements pharmacologiques et aux thérapies comportementales. Chez les femmes en âge de procréer, cette chirurgie de l’obésité diminue la morbimortalité, améliore la fertilité et réduit les principales complications obstétricales: diabète gestationnel, hypertension artérielle (HTA), prééclampsie, etc. On note deux techniques de chirurgie de l’obésité. Les techniques restrictives sont l’anneau gastrique, le sleeve gastrique, les ballons intragastriques qui diminuent l’espace gastrique et qui sont en place pour une durée limitée maximale de six mois. Les techniques malabsorptives se résument essentiellement à la dérivation biliopancréatique. Des techniques mixtes récentes telles que la stimulation gastrique implantable peuvent aussi être proposées. Cette dernière joue un effet de satiété grâce à des impulsions continues délivrées par un pacemaker sous-cutané relié à la sonde de stimulation. Le sleeve gastrique ou gastrectomie longitudinale est actuellement en 2012 la première technique proposée en France chez les patientes avec une obésité morbide. Les techniques malabsorptives entraînent chez les patientes des carences en micronutriments qu’il est nécessaire de dépister par un bilan préconceptionnel et de supplémenter au plus tôt pendant la grossesse afin de limiter le risque de malformation foetale induite. À l’aide d’une revue de la littérature, nous évoquerons les dix points essentiels de la prise en charge obstétricale après une chirurgie bariatrique, le suivi nécessaire et la prise en charge globale et multidisciplinaire afin de nous assurer d’un bon équilibre nutritionnel en vue d’une grossesse le plus proche de la normale et de nouveau-nés sans carence nutritionnelle ni malformation.
Abstract
Obesity is a public health problem, with an incidence not ceasing growing during the last years in Europe and in the USA. Bariatric surgery is the last recourse for these patients with a morbid obesity, in association to hygienodietetic rules, pharmacological treatments, and behavioral therapies. Among women in age to procreate, this surgery of obesity decreases morbi-mortality, and reduces obstetrical complications: gestational diabetes, arterial hypertension, preeclampsia, fetal malformations related to obesity, etc. The two techniques of surgery of obesity are the restrictive techniques (laparoscopic adjustable gastric banding, sleeve gastric) and the malabsorptive techniques. Nowadays, in France, gastric sleeve or longitudinal gastrectomy is the first technique suggested. The malabsorptive techniques involve deficiencies into micro nutriments which have to be detected by a preconceptional assessment and supplemented as soon as possible during the pregnancy in order to avoid any induced fetal malformation. By a review of the literature, the purpose of the present study is to deal with the ten essential points in obstetric care after a bariatric surgery, and the multidisciplinary follow-up to make sure of good psychological and nutritional balance. The aim of such management is to ensure the normal progress of pregnancy and the birth of newborns without deficiency or malformation.
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Wallaert, E., Boulot, P. Les dix points essentiels de la chirurgie bariatrique et obstétrique. Rev. med. perinat. 5, 58–63 (2013). https://doi.org/10.1007/s12611-013-0224-x
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DOI: https://doi.org/10.1007/s12611-013-0224-x