Aktuelle Aspekte der Verfahrenswahl bei Adipositas-Chirurgie

Zusammenfassung

Die Adipositas- bzw. metabolische Chirurgie stellt derzeit evidenzbasiert die einzige Therapiemodalität dar, die bei Patienten mit drittgradiger Adipositas zu einem nachhaltigen und auch klinisch relevanten Gewichtsverlust, zu einer Verbesserung der Lebensqualität und Funktionalität sowie zu einer Minderung vorliegender Adipositas-assoziierter Begleiterkrankungen und damit zu einer Verlängerung der Lebenserwartung führt.

Die Operationen werden vorzugsweise in zertifizierten Zentren mit niedriger perioperativer Morbidität und Letalität in Schlüsselloch-Technik durchgeführt. Die weltweit am häufigsten durchgeführten adipositaschirurgischen Verfahren sind die Sleevegastrektomie (SG), der Roux-en-Y-Magenbypass (RYGB) und der Omega-Loop-Bypass (oder Mini-Gastric-Bypass) (MGB). Daneben existieren weitere intestinale Bypassverfahren.

Die Entscheidung für das jeweilige Operationsverfahren ist im interdisziplinären Konsens von einem Team, bestehend aus Chirurgen, Internisten, Psychiatern/Psychologen und Ökotrophologen, individuell für jeden Patienten in Abhängigkeit der Komorbiditäten und patientenbezogener Daten zu treffen. Im Nachfolgenden werden die verschiedenen Operationsverfahren im Hinblick auf ihre jeweiligen Vor- und Nachteilen miteinander verglichen und auf die für das jeweilige Verfahren am besten geeignete Patientengruppe eingegangen.

Abstract

Based on the available evidence, metabolic and bariatric surgery is the only therapeutic option that leads to sustained and clinically relevant weight loss, significant improvement of functionality and quality of life, as well as attenuation of obesity associated diseases along with prolonged life expectancy in morbidly obese patients. Metabolic surgery is usually performed minimally invasive with low perioperative morbidity and mortality preferably in certified centres. The most commonly performed operations are the sleeve gastrectomy, Roux-en-Y gastric bypass and the omega-loop (mini gastric) bypass. Aside, there are further intestinal bypass procedures available.

A multidisciplinary team of surgeons, internists, psychiatrists/psychologists and ecotrophologists along with the patient should decide together which surgical procedure is the most appropriate depending on individual co-morbidities and patient´s preference. In the following the different surgical procedures will be compared head to head regarding its advantages and disadvantages. Further, we highlight which procedure is the most appropriate for which patient group.

Schlüsselwörter

Adipositas-Chirurgie - metabolische Chirurgie - Verfahrenswahl - Schlauchmagen - Roux-en-Y-Magenbypass

Key words

metaboic surgery - bariatric surgery - treatment options - sleevegastrectomie - Roux-en-Y-gastric-bypass

Publikationsverlauf

Artikel online veröffentlicht:
30. November 2020

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