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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2020; 14(04): 214-220
DOI: 10.1055/a-1267-8215
Review

Metabolische Chirurgie, mehr als nur Typ-2-Diabetes

Metabolic surgery, more than just type 2 diabetes
Annika Rühle
1   Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinik Heidelberg,, Deutschland
,
Andrea Boskovic
1   Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinik Heidelberg,, Deutschland
,
Adrian T. Billeter
1   Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinik Heidelberg,, Deutschland
,
Anne-Catherine Schwarz
1   Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinik Heidelberg,, Deutschland
,
Beat P. Müller-Stich
1   Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinik Heidelberg,, Deutschland
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Zusammenfassung

Die Prävalenzen von Adipositas und metabolischen Erkrankungen wie Diabetes mellitus Typ 2 (DM2), Nicht-alkoholischer Fettlebererkrankung (NAFLD), arterieller Hypertonie (aHT) oder Obstruktiver Schlafapnoe (OSAS) steigen. Die Adipositas-Chirurgie ist nicht nur hinsichtlich des Gewichtsverlustes der konservativen Therapie überlegen, sondern zeigt ebenfalls positive Effekte auf metabolische Erkrankungen. Die meisten Daten finden sich für den DM2, hier kommt es unabhängig vom Gewichtsverlust zu einer besseren glykämischen Kontrolle, Verbesserung mikro- und makrovaskulärer Komplikationen wie der diabetischen Nephropathie oder Polyneuropathie und Reduktion der Mortalität. Bei Patienten mit NAFLD zeigen sich sowohl laborchemisch als auch histologisch Befundverbesserungen bis hin zur Regredienz fibrotischer Veränderungen. Die antihypertensive Medikation kann nach metabolischem Eingriff nachhaltig reduziert oder gar sistiert werden, gleiches gilt für die medikamentöse Therapie der Dyslipidämie. Patienten mit diabetischer Nephropathie oder auch Adipositas-assoziierter Albuminurie profitieren von einer Erholung der Nierenfunktion und Reduktion der Dialysepflichtigkeit. Auch das OSAS, eine häufige Erkrankung adipöser Patienten mit Erhöhung des kardiovaskulären Risikos, zeigt postoperativ eine Befundverbesserung. Diese beginnt sogar schon bevor es zu einem relevanten Gewichtsverlust kommt, welcher zusätzlich die Atemmechanik erleichtert.

Interessanterweise zeigen sich die beschriebenen Effekte nicht nur bei adipösen, sondern auch bei normalgewichtigen Patienten. Der DM2 stellt daher bereits in bestimmten Fällen beim normalgewichtigen Patienten eine Indikation zur metabolischen Chirurgie dar. Eine Anpassung der Leitlinien hinsichtlich anderer metabolischer Erkrankungen steht trotz zunehmender hochklassiger Evidenz diesbezüglich noch aus.

Abstract

The prevalence of obesity and metabolic diseases as type 2 diabetes (DM2), non-alcoholic fatty liver disease (NAFLD), arterial hypertension (aHT) or obstructive sleep apnea (OSAS) is rising. Obesity surgery is not only superior compared to conservative treatments regarding weight loss but also shows positive effects on metabolic diseases. Most data deal with DM2 where patients not only benefit from better glycemic control regardless of weight loss but also show improvement of micro- and macrovascular complications including diabetic nephropathy or polyneuropathy and also have reduced mortality. Patients with NAFLD show improvement of blood parameters as well as histopathological ameliorations including improvement and remission of fibrosis. Antihypertensive medication can be reduced or even stopped after metabolic surgery while similiar effects have been shown for dyslipidemia. Patients with diabetic nephropathy or obesity-associated albuminuria benefit of improved renal function and reduced need of hemodialysis. Furthermore, OSAS, a disease increasing the cardiovascular risk obese patients often suffer from, is ameliorated postoperatively. These effects can already be found before relevant weight reduction further supporting the notion that many effects of obesity surgery are independent of weight loss.

Interestingly, the described effects not only occur in obese patients but also in normal-weight patients. So far, DM2 can comprise an indication for metabolic surgery even in non-obese patients. However, despite existing high-quality evidence for the benefit of metabolic surgery in other diseases such as microalbuminuria, the current guidelines do not include these disease.

Schlüsselwörter

Metabolische Chirurgie - Diabetes mellitus Typ 2 - Nicht-alkoholische Fettlebererkrankung - Obstruktive Schlafapnoe - Niereninsuffizienz

Key words

metabolic surgery - type 2 diabetes - non-alcoholic fatty liver disease - obstructive sleep apnea - renal insufficiency


Publication History

Article published online:
30 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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