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

  • E.A.E.S. Guidelines
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Abstract

Background

The increasing prevalence of morbid obesity together with the development of laparoscopic approaches has led to a steep rise in the number of bariatric operations. These guidelines intend to define the comparative effectivness and surrounding circumstances of the various types of obesity surgery.

Methods

A consensus panel representing the fields of general/endoscopic surgery, nutrition and epidemiology convened to agree on specific questions in obesity surgery. Databases were systematically searched for clinical trial results in order to produce evidence-based recommendations. Following two days of discussion by the experts and a plenary discussion, the final statements were issued.

Recommendations

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.

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Acknowledgments

The authors thank the E.A.E.S. and its congress president, Prof. Antonio M. Lacy (Barcelona), for the opportunity to compile and present these recommendations. The authors are grateful to Prof. John J. Kelly (Worcester, MA, U.S.A.); Dr. Torsten Olbers (Goteborg, Sweden), and Prof. Antonio M. Lacy (Barcelona, Spain) for valuable comments on a drafted version of the manuscript.

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Authors and Affiliations

  1. Conference Organisers on behalf of the Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.), c/o E.A.E.S. Office, Post Office Box 335, Veldhoven, AH, 5500, The Netherlands

    S. Sauerland & E. A. M. Neugebauer

  2. Biochemical and Experimental Division, Medical Faculty, University of Cologne, Ostmerheimer Str. 200, Cologne, D 51109, Germany

    S. Sauerland & E. A. M. Neugebauer

  3. S. Glovanni Bosco Hospital, University Federico II, Naples, Italy

    L. Angrisani

  4. Service de Chirurgie Universitaire, CHRH, 2 rue des Trois Points, Huy, B 4500, Belgium

    M. Belachew

  5. Department of Digestive and General Surgery, Hopital Europeen G Pompidou, Paris, France

    J. M. Chevallier

  6. Obesity Unit, Department of Medical and Surgical Sciences, University of Padova, Contra Chioare, 13, Vicenza, I 36100, Italy

    F. Favretti

  7. Wellcome Clinical Research Facility, Addenbrooke’s Hospital, Hills Road, Cambridge, CB2 2QQ, United Kingdom

    N. Finer

  8. Centre Hospitalier de Poissy-Saint Germain, 10, rue du Champ Gaillard, Poissy Cedex, F 78303, France

    A. Fingerhut

  9. Department of Surgery, Malaga University, Malaga, E 29080, Spain

    M. Garcia Caballero

  10. Mental Health Department, Servicio Extremeno de Salud, Junta de Extremadura, C/ Jesus Rincon Jimenez n° 82, 5° D, Badajoz, 06010, Spain

    J. A. Guisado Macias

  11. Department of General Surgery, University Hospital Innsbruck, Anichstr. 35, Innsbruck, A-6020, Austria

    R. Mittermair

  12. Chirurgia Generale II, Department of Surgery, University of Turin, Corso A.M. Dogliotti 14, Turin, I 10126, Italy

    M. Morino

  13. Service de Chirurgie Generale et Digestive, Hopital Louis Mourier, 78, rue des Renouillers, Colombes, F 92701, France

    S. Msika

  14. Department of Surgery, Hopitaux Uiversitaires, Strasbourg, BP 426 F 67091, France

    F. Rubino

  15. Department of Surgery, Catholic University of Rome, Viale della Tecnica 205, Roma, I 00144, Italy

    R. Tacchino

  16. Department of Surgery, Krankenhaus Sachsenhausen, Schulstr. 31, Frankfurt a.M., D 60594, Germany

    R. Weiner

Authors
  1. S. Sauerland
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  2. L. Angrisani
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  3. M. Belachew
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  4. J. M. Chevallier
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  5. F. Favretti
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  6. N. Finer
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  7. A. Fingerhut
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  8. M. Garcia Caballero
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  9. J. A. Guisado Macias
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  10. R. Mittermair
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Correspondence to E. A. M. Neugebauer.

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Sauerland, S., Angrisani, L., Belachew, M. et al. Obesity surgery: Evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 19, 200–221 (2005). https://doi.org/10.1007/s00464-004-9194-1

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