Skip to main content
SpringerLink
Log in

Verfahrenswahl und Technik der metabolischen Chirurgie

Procedure selection and technique of metabolic surgery

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Die metabolische Chirurgie entwickelt sich zu einer eindrucksvollen Therapieoption des Diabetes mellitus Typ 2 und anderen metabolischen Erkrankungen. Im Vergleich zur konservativen Therapie können mit bariatrischen Verfahren (Magenbypass, Schlauchmagen, Magenband und biliopankreatischer Diversion) sowohl höhere Remissionsraten als auch eine deutliche Verbesserungen des Blutzuckerstoffwechsels erreicht werden. Zunehmend beschreiben Studien Wirkmechanismen, die über das bisherige Verständnis wie Restriktion und Malabsorption hinausgehen. Die aktuelle Literatur deutet darauf hin, dass Magenbypass und Schlauchmagen das günstigste Nutzen-Risiko-Profil erzielen. Magenband und die biliopankreatische Diversion sind in Einzelfällen zu empfehlen.

Abstract

Metabolic surgery is becoming an impressive therapeutic option for type 2 diabetes mellitus and other metabolic diseases. Compared to conservative therapy bariatric procedures, such as gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion, seem to achieve significantly higher remission rates and improvements in blood glucose metabolism. Recent studies describe additional effect mechanisms which go beyond the assumed mechanisms of restriction and malabsorption. The results in the current literature suggest that gastric bypass and sleeve gastrectomy provide the best metabolic risk-benefit profiles. Gastric banding and biliopancreatic diversion can only be recommended in specific cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Brethauer SA, Hammel JP, Schauer PR (2009) Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 5:469–475

    Article  PubMed  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E et al (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122(3):248–256

    Article  PubMed  Google Scholar 

  3. Brown WA, Burton PR, Anderson M et al (2008) Symmetrical pouch dilatation after laparoscopic adjustable gastric banding: incidence and management. Obes Surg 18(9):1104–1108

    Article  PubMed  Google Scholar 

  4. Chang SH, Caroly R, Stoll T et al (2014) The effectivenss and risks of bariatric surgery an updated systematic review and meta-analysis, 2003–2012. JAMA Surg 149(3):275–287

    Article  PubMed  Google Scholar 

  5. Dixon JB, O’Brien PE, Playfair J et al (2008) Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled tiral. JAMA 299(3):248–256

    Google Scholar 

  6. Friedmann MN, Sancetta AJ, Magovern GJ (1955) The amelioration of diabetes mellitus following subtotal gastrectomy. Surg Gynecol Obstet 100:201–204

    Google Scholar 

  7. Hedberg J, Sundström J, Sundbom M (2014) Duodenal switch versus Roux-en-Y gastric bypass for morbid obesity: systematic review and meta-analysis of weight results, diabetes resolution and early complications in single-centre comparisions. Obes Rev 15:555–563

    Article  CAS  PubMed  Google Scholar 

  8. IDF Diabetes Atlas 5th edition, 2012 update

  9. Li JF, Lai DD, Ni B et al (2013) Comparison of laparoscopic Roux-en-Y gastric bypass with laparoscopic sleeve gastrectomy for morbid obesity or type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Can J Surg 56:158–164

    Article  Google Scholar 

  10. Marceau P, Biron S, St Georges R et al (1991) Biliopancreatic diversion with gastrectomy as surgical treatment of morbid obesity. Obes Surg 1:381–387

    Article  PubMed  Google Scholar 

  11. Mason EE, Ito C (1967) Gastric bypass in obesity. Surg Clin North Am 47(6):1345–1351

    CAS  PubMed  Google Scholar 

  12. Mingrone G, Panunzi S, De Gaetano A et al (2012) Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 366(17):1577–1585

    Article  CAS  PubMed  Google Scholar 

  13. Ng M, Fleming T, Robinson M et al (2014) Global, regional, and national prevalence of overweight a in children and adults during 1980–2013: a systematic analy thee Global Burden of Disease Study 2013. Lancet (Early Online Publication, 29 May 2014)

  14. Parikh M, Issa R, Vieira D et al (2013) Role of bariatric surgery as treatment for type 2 diabetes in patients who do not meet current NIH criteria: a systematic review and meta-analysis. J Am Coll Surg 217(3):527–532

    Article  PubMed  Google Scholar 

  15. Pories WJ, Swanson MS, MacDonald KG et al (1995) Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 222(3):339–350

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Reames BN, Fink JF, Bacal D et al (2014) Changes in bariatric surgery procedure use in Michigan, 2006–2013. JAMA 312(9):959–961

    Article  PubMed  Google Scholar 

  17. S3 Leitlinie Chirurgie der Adipositas 2010, AWMF online

  18. Schauer PR, Kashyap SR, Wolski K et al (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366(17):1567–1576

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Schauer PR, Bhatt DL, Kirwan JP et al (2014) Bariatric surgery versus intensive medical therapy for diabetes – 3 year outcomes. N Engl J Med 370:2002–2013

    Article  CAS  PubMed  Google Scholar 

  20. Scopinaro N, Gianetta E, Pandolfo N et al (1976) Bilio-pancreatic bypass. Proposal and preliminary experimental study of a new type of operaion for the functional surgical treatment of obesity. Minerva Chir 31:560–566

    CAS  PubMed  Google Scholar 

  21. Sjöström L, Narbro K, Sjöströ CD et al (2007) Swedish obese subjects study. Effect of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357:741–752

    Article  PubMed  Google Scholar 

  22. Stefater MA, Wilson-Perez HE, Chambers AP et al (2012) All Bariatric Surgeries are not created equal: insights from mechanistic comparisons. Endocr Rev 33(4):595–622

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Tham JC, Howes N, Roux CW le (2014) The role of bariatric surgery in the treatment of diabetes. Ther Adv Chronic Dis 5(3):149–157

    Article  PubMed Central  PubMed  Google Scholar 

  24. Wang S, Li P, Sun FX et al (2013) Comparision between laparoscopic sleeve gastretomy and laparoscopic adjustable gastrci banding for morbid obesity: a meta-analysis. Obes Surg 23:980–986

    Article  PubMed Central  PubMed  Google Scholar 

  25. Yip S, Plank LD, Murphy R (2013) Gastric bypass and sleeve gastrectomy for type 2 diabetes: a systematic review and meta-analysis of outcomes. Obes Surg 23:1994–2003

    Article  PubMed  Google Scholar 

  26. Zhang C, Yuan Y, Qui C et al (2014) A meta-analysis of 2 year effect after surgery. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for morbid obesity and diabetes mellitus. Obes Surg (Published online: 10 June 2014)

    Google Scholar 

  27. Jurowich C, Germer CT, Seyfried F, Thalheimer A (2012) Metabolische Chirurgie. Chirurg 83:583–600

    Article  CAS  PubMed  Google Scholar 

Download references

Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Ordemann, U. Elbelt und C. Menenakos geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

Author information

Authors and Affiliations

  1. Zentrum für Adipositas und Metabolische Chirurgie, Klinik für Allgemein-, Visceral-, Gefäß- und Thoraxchirurgie, Charité – Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland

    J. Ordemann & C. Menenakos

  2. Medizinische Klinik m.S. Endokrinologie, Diabetes und Ernährungsmedizin, Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland

    U. Elbelt

Authors
  1. J. Ordemann
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Elbelt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Menenakos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Ordemann.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ordemann, J., Elbelt, U. & Menenakos, C. Verfahrenswahl und Technik der metabolischen Chirurgie. Chirurg 85, 969–974 (2014). https://doi.org/10.1007/s00104-014-2798-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-014-2798-7

Schlüsselwörter

Keywords

Search

Navigation