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1 JMBS J Metab Bariatr Surg 2018;7(2): ORIGINAL ARTICLE 년비만대사수술전국조사결과보고 1 연세대학교강남세브란스병원, 2 중앙대학교병원, 3 검단탑병원, 4 단국대학교병원, 5 가톨릭대학교성바오로병원, 6 가천대학교길병원, 7 조선대학교병원, 8 순천향대학교서울병원, 9 가톨릭대학교여의도성모병원, 10 고려대학교안산병원, 11 웰니스병원, 12 가톨릭대학교인천성모병원, 13 전남대학교병원, 14 계명대학교동산병원, 15 분당서울대학교병원, 16 울산대학교병원, 17 고려대학교안암병원, 18 서울슬림외과, 19 칠곡경북대학교병원, 20 고신대학교복음병원, 21 인제대학교해운대백병원, 22 한림대학교성심병원, 23 서울대학교보라매병원, 24 서울아산병원, 25 가톨릭대학교대전성모병원, 26 가톨릭대학교서울성모병원, 27 가톨릭대학교의정부성모병원, 28 서울대학교병원, 29 가톨릭대학교성빈센트병원, 30 성균관대학교강북삼성병원, 31 서울 365MC 병원, 32 가톨릭관동대학교국제성모병원, 33 한양대학교병원, 34 차의과대학교강남차병원, 35 아주대학교병원, 36 인하대학교병원, 37 연세대학교세브란스병원, 38 이화여자대학교의료원외과 권인규 1, 김종원 2, 강길호 3, 김동욱 4, 김성근 5, 김성민 6, 김성수 7, 김용진 8, 김욱 9, 김종한 10, 김지헌 11, 김진조 12, 김호군 13, 류승완 14, 박도중 15, 박동진 16, 박성수 17, 박윤찬 18, 박중민 2, 박지연 19, 서경원 20, 서병조 21, 안수민 22, 안혜성 23, 유문원 24, 이상권 25, 이한홍 26,27, 이혁준 28, 전경화 29, 정경욱 30, 조민영 31, 최승호 1, 하만호 32, 하태경 33, 한상문 34, 한상욱 35, 허윤석 36, 형우진 37, 이주호 38, 대한비만대사외과학회정보전산위원회 Nationwide Bariatric and Metabolic Surgery Report in Korea In Gyu Kwon 1, Jong Won Kim 2, Gil Ho Kang 3, Dong Wook Kim 4, Sung Geun Kim 5, Seong Min Kim 6, Seong Soo Kim 7, Yong Jin Kim 8, Wook Kim 9, Jong-Han Kim 10, Ji Heon Kim 11, Jin-Jo Kim 12, Ho Goon Kim 13, Seung Wan Ryu 14, Do-Joong Park 15, Dong Jin Park 16, Sung-Soo Park 17, Yoon-Chan Park 18, Joong-Min Park 2, Ji Yeon Park 19, Kyung Won Seo 20, Byoung Jo Suh 21, Soo Min Ahn 22, Hye Seong Ahn 23, Moon-Won Yoo 24, Sang Kuon Lee 25, Han Hong Lee 26,27, Hyuk-Joon Lee 28, Kyong-Hwa Jun 29, Kyung Ook Jung 30, Minyoung Cho 31, Seung Ho Choi 1, Man-ho Ha 32, Tae Kyung Ha 33, Sang-Moon Han 34, Sang-Uk Han 35, Yoon-Seok Heo 36, Woo Jin Hyung 37, Joo Ho Lee 38, on behalf of the Information Committee of the Korean Society of Bariatric and Metabolic Surgery Departments of Surgery, 1 Yonsei University Gangnam Severance Hospital, 2 Chung-Ang University Hospital, Seoul, 3 Gumdan Top General Hospital, Incheon, 4 Dankook University Hospotal, Cheonan, 5 Catholic University of Korea, St. Paul s Hospital, Seoul, 6 Gachon University Gil Medical Center, Incheon, 7 Chosun University Hospital, Gwangju, 8 Soonchunhyang University Seoul Hospital, 9 Catholic University of Korea, Yeouido St. Mary s Hospital, Seoul, 10 Korea University Ansan Hospital, Ansan, 11 Wellness Hospital, Busan, 12 Catholic University of Korea, Incheon St. Mary s Hospital, Incheon, 13 Chonnam National University Hospital, Gwangju, 14 Keimyung Univsity Dongsan Hospital, Daegu, 15 Seoul National University Bundang Hospital, Seongnam, 16 Ulsan University Hospital, Ulsan, 17 Korea University Anam Hospital, 18 Seoul Slim Surgery, Seoul, 19 Kyungpook National University Chilgok Hospital, Daegu, 20 Kosin University Gospel Hospital, 21 Inje University Haeundae Paik Hospital, Busan, 22 Hallym University Sacred Heart Hospital, Anyang, 23 Seoul National University-SMG Boramae Hospital, 24 Asan Medical Center, Seoul, 25 Catholic University of Korea, Daejeon St. Mary s Hospital, Daejeon, 26 Catholic University of Korea, Seoul St. Mary s Hospital, 27 Catholic University of Korea, Uijeongbu St. Mary s Hospital, 28 Seoul National University Hospital, Seoul, 29 Catholic University of Korea, St. Vincent s Hospital, Suwon, 30 Kangbuk Samsung Hospital, 31 Seoul 365MC Hospital, Seoul, 32 Catholic Kwandong University International St. Mary's Hospital, Incheon, 33 Hanyang University Medical Center, Seoul, 34 CHA University Hospital, Seoungnam, 35 Ajou University Hospital, Suwon, 36 Inha University Hospital, Incheon, 37 Yonsei University Severance Hospital, 38 Ewha Medical Center, Seoul, Korea 투고일 : 2018 년 11 월 7 일, 심사일 : 2018 년 11 월 28 일, 게재확정일 : 2018 년 12 월 3 일책임저자 : 김종원, 서울시동작구흑석로 102 중앙대학교병원외과우 : Tel: , Fax: , drholy@gmail.com CC This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright 2018, The Korean Society for Metabolic and Bariatric Surgery

2 Vol. 7, No. 2, 2018 Purpose: The information committee of the Korean Society for Metabolic and Bariatric Surgery (KSMBS) performed the nationwide survey of bariatric and metabolic operations to report IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) worldwide survey annually. This study aimed to report the trends of bariatric and metabolic surgery in Korea in Materials and Methods: We analyzed the accumulated nationwide survey data conducted for annual ISFO survey from 2014 to Trends such as the number of operations by hospital type and the number of operations by surgical method were analyzed. Results: The number of operations has decreased sharply in 2015 comparing to 2014 ( ). The number of operations performed in private hospitals dropped sharply from 529 to 250, 198, and 103 cases. The number of revisional surgeries increased to 223 in The primary surgery number fell from 757 in 2014 to 327 in In primary surgery, sleeve gastrectomy was gradually increased from 2014 to 143 (18.9%), 105 (32.1%), 167 (47.2%) and 200 (56.3%) and became the most frequently performed surgery. On the other hand, the incidence of adjustable gastric band decreased gradually from 439 (58.0%) to 117 (35.8%), 112 (31.6%) and 59 (16.6%). Conclusion: The overall number of obesity metabolic operations has decreased since 2014, especially the number of adjustable gastric band, and the number of operations in private hospitals declined sharply. On the other hand, the number of operations in university hospitals did not change much, and the number of sleeve gastrectomy increased. Key Words: Bariatric surgery, Metabolic surgery, Korea, Survey 서론 비만대사수술은고도비만에서가장효과적인치료방법으로알려져있다 [1,2]. 비만대사수술에있어서여러가지수술방법이고안되었고, 시기에따라각수술방법의시행빈도에변화가있었다. 대표적인비만대사국제학회인 IFSO (International Federation for the Surgery of Obesity and Metabolic Disorders) 에서는비만대사수술에관하여매년전세계적인조사를시행해왔으며, 주기적으로그결과를보고하고있다 [3,4]. 전세계적인수술시행의추세나세계지역별추세는 IFSO의보고를통해서알수있으나, 우리나라의비만대사수술현황에대해서는자료가부족하다. 대한비만대사외과학회는 IFSO에서시행하고있는세계적인조사에참여하여국내조사를담당해왔으며, 전세계자료가취합되는데협조해왔다. 대한비만대사외과학회에서는 2003년부터 2013년까지의국내비만대사수술 관련자료를조사하여보고한바가있다 [5]. 하지만, 그이후에국내에서는비만대사수술관련하여많은변화가있었다. 따라서 IFSO의세계적인조사를위해국내에서취합한정보를정리하여보고함으로써국내비만대사수술의변화를공유하고자한다. 기존에발표된 2013년까지를제외한 2014년에서 2017년까지의현황을보고하겠다. 대상및방법 IFSO에서는대한비만대사외과학회측에비만대사수술현황조사를위한형식을매년보내온다 [4]. 대한비만대사외과학회에서는학회회원들에게취지와함께데이터수집형식을보낸뒤회신을받고취합하여 IFSO에전달해왔다. 데이터수집에있어서개인정보는전혀없으며, 각기관별로비만대사수술및수술별연간건수에대한기록만포함된다. 학회에서는조사에참 Table 1. Types of hospitals participated by year N (%) Year 2014 (N=33) 2015 (N=34) 2016 (N=35) 2017 (N=37) Private University Private University Private University Private University No. of operations 4 (12.1) 29 (87.9) 3 (8.8) 31 (91.2) 3 (8.6) 32 (91.4) 4 (11.1) 32 (88.9) (3.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 100 &<200 1 (3.0) 1 (3.0) 2 (5.9) 0 (0.0) 0 (0.0) 1 (2.9) 0 (0.0) 2 (5.6) 50 &<100 1 (3.0) 2 (6.1) 0 (0.0) 3 (8.8) 2 (5.7) 2 (5.7) 1 (2.8) 1 (2.8) 10 &<50 1 (3.0) 1 (3.0) 1 (2.9) 2 (5.9) 1 (2.9) 1 (2.9) 1 (2.8) 1 (2.8) <10 0 (0.0) 25 (75.6) 0 (0.0) 26 (76.5) 0 (0.0) 28 (80.0) 2 (5.6) 28 (77.8) Each percentage is the percentage of total participating organizations by year. 50

3 권인규외 : 년비만대사수술전국조사보고 여를독려하지만강제성을가지고있지는않다. 결과 참여기관수는 2014년부터연도별로각각 33, 34, 35, 36개기관이었고, 그중에대학병원이 29, 31, 32, 32개기관이었다. 각연도별로수술건수별기관분포를 Table 1에정리하였다. 대부분의병원에서 10건미만의수술이시행되고있었고, 소수의병원에서대부분의수술이이뤄지고있었다 (Table 1). 전체수술건수는 2014년 913례에서 550, 550, 531례로줄어들고있으며, 특히개인전문병원에서시행되는수술건수가 많이줄었다. 대학병원에서시행되는수술건수는큰변화는없으나, 점차조금씩늘고있는추세를보여준다 (Fig. 1). 2014년에는전체수술중 17.1% 가교정수술 (Revisional surgery) 이었는데, 이후에는 40.5%, 35.6%, 33.1% 로교정수술의비율이증가하였다 (Fig. 2). 각연도별로시행된수술을종류별로일차수술과교정수술로나누어 Table 2에정리하였다. 일차수술에서소매절제술의비율이점차증가하고있었다 (2014년부터각연도별로18.9%, 32.1%, 47.2%, 56.3%). 일차수술에서밴드수술의비율이감소하고있고, 교정수술에서밴드제거술이대부분을차지하고있다. 2015년에교정수술이가장많았으며, 이중 80.3% 가밴드제 Fig. 1. The number of annual operation cases according to type of hospital. Fig. 2. The number of annual operation cases according to whether primary or revisional surgery. Table 2. Operation type (N(%)) 2014 (N=913) 2015 (N=550) 2016 (N=550) 2017 (N=531) Primary Revision Primary Revision Primary Revision Primary Revision Total 757 (82.9) 156 (17.1) 327 (59.5) 223 (40.5) 354 (64.4) 196 (35.6) 355 (66.9) 176 (33.1) AGB 439 (58.0) 1 (0.6) 117 (35.8) (31.6) 0 59 (16.6) 0 RYGB 125 (16.5) 16 (10.3) 78 (23.9) 2 (0.9) 56 (15.8) 3 (1.5) 82 (23.1) 8 (4.5) SG 143 (18.9) 13 (8.3) 105 (32.1) 11 (4.9) 167 (47.2) 33 (16.8) 200 (56.3) 27 (15.3) G-Plication 49 (6.5) 0 26 (8.0) 2 (0.9) 12 (3.4) 0 5 (1.4) 1 (0.6) D-Switch 1 (0.1) 0 1 (0.3) OAGB (2.0) 0 9 (2.5) 0 SGJB (1.5) Band removal (69.9) (80.3) (66.8) (65.9) Band revision 0 13 (8.3) 0 9 (4.0) 0 7 (3.6) 0 16 (9.1) Reversal (0.4) 0 1 (0.5) 0 0 others 0 4 (2.6) $ (4.5)* AGB = adjustable gastric banding; RYGB = roux-en-y gastric bypass; SG = sleeve gastrectomy; G-Plication = gastric plication; D-Switch = duodenal switch; OAGB = one anastomosis gastric bypass; SGJB = sleeve gastrectomy with jejunal bypass; Reversal = reversal after roux-en-y gastric bypass. $ They were reported just as others. *5 Tummy tuck, 2 Internal hernia, 1 Umbilical hernia. 51

4 Vol. 7, No. 2, 2018 거술이었다. 일차수술에대해서수술종류별추이를보기위하여그래프로나타내었다. 2014년에가장많이시행되던조절형위밴드삽입술은점차감소하고있으며, 위소매절제술은증례수가점차증가하여현재로서는가장많이시행되고있는수술이되었다 (Fig. 3). 고찰 2013년도에시행한자세한조사가아닌, 수술건수에대해간략하게했던조사결과를모은것이기때문에, 대상환자의특성이나수술결과가없다는점이아쉽지만, 국내에서시행된비만대사수술의현황을살펴볼수있는자료라고생각된다. 2013년시행된비만대사수술전국조사결과와비교하면, 2013년까지빠르게증가하던수술건수가 2014년부터급격히줄어들었고, 교정수술건수가많아졌다. 또한, 개인전문병원수술건수는급격히감소하는반면대학병원의수술건수는큰변화가없다는것을알수있었다. 이는 2014년국내유명가수인 S 씨가조절형위밴드삽입술과관련되어사망한사건이발생하여사회적으로크게이슈화되었던것때문으로풀이된다. 사건의개요는조절형위밴드를삽입했다가, 제거하고지내던중에유착성장폐색이발생하여, 수술을받았고, 이후합병증이발생하여사망한것이다. 이사건으로조절형위밴드삽입술의후유증에대한관심이급증하였고, 그이후에는개인전문병원에서주 로시행되던조절형위밴드삽입술건수가급감하였고, 밴드제거술건수는증가하였다 (Table 2). 하지만그사건은 2014년 10 월말에발생하였기때문에 2013년 1210건시행되었던조절형위밴드삽입술이 2014년에 439건으로감소했다는것을온전히설명해줄수는없다 [5]. 오히려 2014년도에이미밴드제거술건수가 109례인것을보면, 장기적인밴드관련문제를인지하면서점차로위밴드삽입술이감소추세에접어든상태에서, 밴드후유증관련사망사건이크게이슈화되면서, 감소추세를부추긴것으로보인다 (Table 2). IFSO의전세계조사결과에따르면 2013년을지나면서위소매절제술이가장많이시행되고있는것을알수있는데, 우리나라의경우는세계적인추세와달리 2015년까지조절형위밴드삽입술이가장많이시행되어왔었다. 그러나 2016년이후로는세계적인추세와마찬가지로위소매절제술수술건수가가장많이차지하게되었다 (Fig. 3) [4]. 다만특이한점은 IFSO의전세계조사결과에는루와이위우회술이전통적으로가장많이시행되는수술이었다가최근에위소매절제술이가장많이시행되는수술이되었는데, 우리나라의경우는루와이위우회술이위소매절제술보다더많이시행된적이 2014년부터 2017년기간에는없으며, 이미보고된 2003년부터 2013년까지의결과를봐도 2005년과 2007년, 2008년, 2009년, 2012년정도뿐이며다른해에는위소매절제술이더많이시행되었다 [4,5]. 우리나라는위암발생율이높은데, 루와이위우회술후에우회되는위낭이추후내시경접근이어려워위암에대한검진이어렵다는점이수술방법선택에영향을미쳤을것으로생각된다. 우리나라에서시행된루와이위우회술환자에서위낭에발생한위암에대한장기추적결과에대한보고가필요할것으로생각된다. 결론 국내에서비만대사수술은 2014년이후수술건수가많이감소하였으며, 특히조절형위밴드삽입술이많이감소하였고, 개인전문병원에서시행된수술건수가급격히감소하였다. 세계적인추세와비슷하게우리나라에서도위소매절제술의시행건수가점차증가하여가장많이시행되는수술이되었다. 감사의글 Fig. 3. Trend in primary bariatric and metabolic surgical procedures. AGB = adjustable gastric banding; RYGB = roux-en-y gastric bypass; SG = sleeve gastrectomy; G-Plication = gastric plication; D-Switch = duodenal switch; OAGB = one anastomosis gastric bypass; SGJB = sleeve gastrectomy with jejunal bypass. 조사에적극응답을해주신 39개기관의회원분들과정보전산위원회의활동을적극지원해주신대한비만대사외과학회관계자분들께감사드린다. 52

5 권인규외 : 년비만대사수술전국조사보고 REFERENCES 1. Heo YS, Park JM, Kim YJ, et al. Bariatric surgery versus conventional therapy in obese Korea patients: a multicenter retrospective cohort study. J Korean Surg Soc 2012;83: Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev 2014;(8): CD Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO Worldwide Survey Obes Surg 2017;27: Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg 2018;28: Lee HJ, Ahn HS, Choi YB, et al. Nationwide survey on bariatric and metabolic surgery in Korea: results. Obes Surg 2016;26:

패션 전문가 293명 대상 앙케트+전문기자단 선정 2010.1 Fashionbiz CEO Managing Director Creative Director Independent Designer

READY-TO-WEAR Fashionbiz 2010.1 패션 전문가 293명 대상 앙케트+전문기자단 선정 2010.1 Fashionbiz CEO Managing Director Creative Director Independent Designer READY-TO-WEAR Fashionbiz 2010.1 1 2 3 4 5 6 7 8 9 9 2010.1 Fashionbiz