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Chirurgie als pluripotentes Instrument gegen eine metabolische Erkrankung

Was sind die Mechanismen?

Surgery as pluripotent instrument for metabolic disease

What are the mechanisms?

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Zusammenfassung

Die bariatrische/metabolische Chirurgie stellt derzeit die effektivste Therapie zur dauerhaften Gewichtsreduktion und Verbesserung der mit Adipositas assoziierten metabolischen Begleiterkrankungen wie Diabetes mellitus Typ 2, arterielle Hypertonie, Lipidstoffwechselstörungen und kardiovaskuläre Erkrankungen dar. Trotz kontinuierlich steigender Operationszahlen in Deutschland und weltweit sowie belegter Effektivität sind die genauen Wirkmechanismen der Operationsverfahren jedoch nicht vollständig geklärt. Einer der am häufigsten durchgeführten und am besten untersuchten Eingriffe ist der Roux-en-Y-Magenbypass (RYGB), dessen Wirksamkeit traditionell durch mechanische Nahrungsrestriktion und kalorische Malabsorption begründet wurde. Inzwischen hat sich allerdings gezeigt, dass die zugrunde liegenden Mechanismen weitaus komplexer sind und dass physiologische Prozesse wie beispielsweise veränderte Spiegel verschiedener gastrointestinaler Hormone, ein gesteigerter Energieumsatz und eine modifizierte Zusammensetzung des intestinalen Mikrobioms eine wichtigere Rolle spielen. Nachdem die Verbesserung der metabolischen Begleiterkrankungen lange Zeit als Folgeeffekt der Gewichtsreduktion nach RYGB interpretiert wurde, hat sich inzwischen gezeigt, dass dies zumindest teilweise gewichtsunabhängig zu sein scheint und direkt durch physiologische Veränderungen vermittelt wird. Dieser Artikel soll eine Übersicht zu den potenziellen und aktuell wichtigsten Wirkmechanismen der RYGB-Operation liefern, die sowohl an der Therapie des Übergewichts als auch der adipositasassoziierten metabolischen Begleiterkrankungen beteiligt sind.

Abstract

Bariatric metabolic surgery currently offers the most effective treatment to achieve sustained weight loss and improvement in metabolic comorbidities, such as type 2 diabetes, hypertension, dyslipidemia and cardiovascular diseases. The number of cases performed in Germany and also worldwide is continuously increasing but the underlying mechanisms of bariatric metabolic surgery are still not completely elucidated. Roux-en-Y gastric bypass (RYGB) surgery represents one of the most commonly used and therefore most frequently investigated bariatric metabolic procedures. Traditionally, its effectiveness was attributed to food restriction and malabsorption but in the meantime it has become evident that the underlying postoperative mechanisms of RYGB seem to be much more complex. Potential mechanisms include multiple physiological changes, such as altered levels of gastrointestinal hormones, increased energy expenditure and modified gut microbiota as well as many other factors. This review article therefore aims to offer an up to date overview of relevant mechanisms that improve obesity and its associated comorbidities after RYGB surgery.

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Interessenkonflikt

C. Corteville, M. Fassnacht und M. Bueter geben an, dass kein Interessenkonflikt besteht.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemein-, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Würzburg, Deutschland

    C. Corteville

  2. Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg, Deutschland

    M. Fassnacht

  3. Klinik für Viszeral- und Transplantationschirurgie, Universitätsspital Zürich, Rämistr. 100, 8091, Zürich, Schweiz

    M. Bueter

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  1. C. Corteville
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  2. M. Fassnacht
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  3. M. Bueter
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Correspondence to M. Bueter.

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Corteville, C., Fassnacht, M. & Bueter, M. Chirurgie als pluripotentes Instrument gegen eine metabolische Erkrankung. Chirurg 85, 963–968 (2014). https://doi.org/10.1007/s00104-014-2796-9

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