Der Stellenwert neuerer Verfahren in der Adipositaschirurgie (SADI, SASI und Co.)

Die Adipositaschirurgie bietet die effektivste Therapieoption für die Adipositas und ihre Nebenerkrankungen. Von Beginn an unterlag diese Chirurgie einem steten Wandel. Durch Modifikationen etablierter OP-Methoden wollen die neueren Verfahren die Invasivität und die unerwünschten Wirkungen reduzieren. Der folgende Beitrag zeigt, inwieweit dies gelingt und welche Verfahren das Potenzial zum Standardverfahren haben.

Kernaussagen

• Die SADI ist im Gegensatz zum Original BPD-DS als Primärverfahren durchführbar, scheint jedoch aufgrund der gastrointestinalen Nebenwirkungen vor allem im Stufenkonzept und als Sekundäreingriff nach SG an Bedeutung zu gewinnen.

• Von den neueren Verfahren sind der MGB-OAGB und die SADI bisher am besten in der Adipositaschirurgie etabliert. Vor allem die Bedeutung des MGB-OAGB nimmt als Primär- wie auch als Sekundäroperation nach SG weiter zu.

• Die SASI bietet im Vergleich dazu Vorteile aufgrund der postoperativen endoskopischen Zugänglichkeit des Duodenums und besserer Ergebnisse in Bezug auf GERD, hat jedoch auch Nachteile wie den Gallereflux in Magen und Ösophagus. Ob sich langfristig die SASI als Ein-Anastomosen-Variante und/oder die TB als Roux-Y-Variante durchsetzen wird, kann heute angesichts der bislang nur kurzfristigen Ergebnisse noch nicht beurteilt werden.

• Bei der IT handelt es sich vor allem um ein experimentelles Verfahren, das am Tiermodell sehr gute Einblicke in Stoffwechselveränderungen gibt. Beim Menschen liegen noch zu wenige Daten vor und diese meist in Kombination mit einer SG.

• Die laparoskopische GP wird sich höchstwahrscheinlich aufgrund eines im Vergleich zum SG nicht so günstigen Komplikations-Nutzen-Verhältnisses nicht durchsetzen.

Schlüsselwörter

Adipositaschirurgie - SADI - SASI - Transit Bipartition - Gastric Plication

Publication History

Article published online:
16 June 2022

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