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Indikation und Prinzipien der metabolischen Chirurgie

Indications and principles of metabolic surgery

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Zusammenfassung

Die Adipositaschirurgie ist die effektivste und langfristig wirksamste Maßnahme in der Behandlung der krankhaften Adipositas und vieler ihrer Folgeerkrankungen. Eine neue Evidenzlage zeigt die Effektivität der operativen Maßnahmen in der Behandlung des metabolischen Syndroms, einschließlich des Diabetes mellitus Typ 2, der Hypertonie, der Cholesterinerhöhung, der nichtalkoholischen Lebererkrankungen und der Schlafapnoe. Die Chirurgie der Adipositas geht weit über den Gewichtsverlust hinaus. Die chirurgischen Maßnahmen können zur kompletten Remission eines Diabetes Typ 2 und anderer das Leben verkürzenden Erkrankungen bei den meisten der Patienten beitragen. Der neue Begriff „metabolische Chirurgie“ reflektiert die erweiterte Indikationsstellung der Chirurgie. Daher kann erwartet werden, dass die metabolische Chirurgie eine zunehmende Bedeutung im Management dieser Erkrankungen erlangen wird. Neueste Forschungsergebnisse zeigen, dass die metabolische Chirurgie die Insulinresistenz und -sekretion unabhängig vom Gewichtsverlust durch eine Beeinflussung gastrointestinaler Hormone verbessern kann. Viele Patienten mit einem Diabetes mellitus Typ 2 zeigen eine komplette Remission der Erkrankung wenige Tage nach der metabolischen Chirurgie, noch lange bevor ein signifikanter Gewichtsverlust eingetreten ist. Diese Tatsache führt zu einem neuen Ansatz, die metabolische Chirurgie auch bei den Diabetikern einzusetzen, die normal- und leicht übergewichtig sind.

Abstract

Bariatric surgery is known to be the most effective and long lasting treatment for morbid obesity and many related conditions, but now mounting evidence suggests it may be among the most effective forms of treatment for metabolic diseases and conditions including type 2 diabetes, hypertension, high cholesterol levels, non-alcoholic fatty liver disease and obstructive sleep apnea. Surgery for severe obesity goes way beyond weight loss. This surgery results in the complete remission or significant improvement of type 2 diabetes and other life-threatening diseases in most patients. The new name metabolic surgery was created and reflects this expanded and evolving view of surgery. Therefore, metabolic surgery is expected to play an ever increasing role in managing these diseases. New research results indicate that metabolic surgery may improve insulin resistance and secretion by mechanisms independent of weight loss, most likely involving changes in gastrointestinal hormones. Many patients with type 2 diabetes experience complete remission within days of metabolic surgery, long before significant weight is lost. This has led to a new concept that metabolic surgery may also be appropriate for diabetic individuals who are of normal weight or only slightly overweight.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Der Autor Prof. Dr. Rudolf A. Weiner führt Trainingskurse für Chirurgen in Zusammenarbeit mit den Firmen Ethicon Endosurgery, Covidien, Storz und AMI durch. Die Honorare fließen dem Drittmittelkonto der Klinik zu.

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  1. Chirurgische Klinik des Krankenhauses Sachsenhausen, Schulstraße 31, 60594, Frankfurt am Main, Deutschland

    R.A. Weiner

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Weiner, R. Indikation und Prinzipien der metabolischen Chirurgie. Chirurg 81, 379–396 (2010). https://doi.org/10.1007/s00104-009-1859-9

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