Operative Technik und deren Outcome in der metabolischen Chirurgie: Konventioneller und Banded Gastric Bypass

 

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Zusammenfassung

Hintergrund: Die Adipositas und ihre Folgeerkrankungen nehmen in Deutschland, Europa und weltweit zu. Damit wird die Adipositaschirurgie zur Behandlung von Patienten mit maligner Adipositas immer bedeutender. Der Magenbypass ist eine der am häufigsten durchgeführten Operationen gegen die Fettsucht. Diskussion: Der Magenbypass wird seit 1966 zur operativen Gewichtsreduktion bei adipösen Patienten eingesetzt. In dieser Zeit wurden verschiedene Modifikationen entwickelt. So stellt beispielsweise die laparoskopische Durchführung den aktuellen Standard dar. Nach der Operation verlieren die Patienten große Anteile ihres Übergewichtes (EWL = Excess Weight Loss), in der Regel zwischen 61 und 83 %. Auch die Begleiterkrankungen der Adipositas bessern sich deutlich und werden in einem hohen Prozentsatz durch die Operation sogar geheilt. Bemerkenswert ist, dass sich der Diabetes mellitus Typ II bereits kurz nach der Operation, bevor der Gewichtsverlust einsetzt, verbessert. Das lässt vermuten, dass die Operation mehr als „nur” einen Gewichtsverlust induziert. Schlussfolgerungen: Der Magenbypass ist eine seit Jahrzehnten bekannte Standardoperation ­gegen das Übergewicht, die zusätzlich zur Gewichtsreduktion den Diabetes mellitus Typ II therapiert.

Abstract

Background: The prevalence of morbid obesity and its sequelae is increasing in Germany, Europe and worldwide. Bariatric surgery is thus gaining in importance for the treatment of patients with malignant obesity. Creation of a gastric bypass is one of the most frequently performed procedures for obesity. Discussion: The gastric bypass has been used ­since 1966 as a surgical means of weight reduc­tion in obese patients. In the mean time various modifications have been developed. Thus, for example, the laparoscopic procedure represents the current standard. After the operation most patients experience an excess weight loss (EWL) of between 61 and 83 %. The comorbidities of obesity are also markedly improved and in a high percentage even cured after the operation. It is wor­thy of note that diabetes mellitus type II improves shortly after the operation even before any weight loss has occurred. The suggests that the operation induces more than “just” a loss of weight. Conclusion: For decades the gastric bypass has been a well known standard operation of overweight and, in addition to the reduction in weight, is also a therapy for diabetes mellitus ­type II.

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Dr. med. P. Busch

Universitätsklinikum Hamburg-Eppendorf

Martinistraße 52

20246 Hamburg

Phone: +49 / 40 / 7 41 00

Email: pbusch@uke.uni-hamburg.de