Langzeitergebnisse der bariatrischen Chirurgie bei morbider Adipositas

Zusammenfassung

Adipositas ist eine multifaktorielle, genetisch determinierte, neuroendokrine, chronische Erkrankung. Ernährungsumstellung, Bewegung und/oder andere Maßnahmen führen langfristig bei Patienten mit Adipositas Grad II–III mit einem BMI > 35 kg/m2 oft nicht zum gewünschten Erfolg. Chirurgische Verfahren werden seit 1954 eingesetzt. Die Methodik wird seitdem kontinuierlich optimiert. Grundsätzlich werden zwei Verfahren unterschieden: Restriktion ohne oder mit zusätzlicher Malabsorption. Langfristig kann bei rein restriktiven Verfahren eine Übergewichtsreduktion von rund 50 Prozent, bei zusätzlicher Malabsorption bis zu 75 Prozent erreicht werden. Alle Methoden bewirken eine deutliche Verbesserung oder gar Elimination der adipositas assoziierten Begleiterkrankungen und eine dramatische Verbesserung der Lebensqualität. In gut dokumentierten Langzeitstudien beträgt die perioperative Mortalität 0,2–1,0 Prozent je nach Verfahren, die Morbidität maximal 20 Prozent. Die adipositas chirurgischen Maßnahmen sind evidenzbasiert als sichere und effektive Maßnahmen anerkannt.

Summary

Obesity is a multifactorial, genetically-determined, neuroendocrine, and chronic condition. Change of eating behaviour, physical activity and/or other treatment of patients with class II and III obesity (BMI > 35 kg/m2) has only modest long-term success. Surgical procedures have been used since 1954, and the methods used are continually being updated and improved. Basically, we distinguish between two different procedures: restriction with or without malabsorption. With experienced surgeons, patients can achieve a weight reduction from around 50 % with purely restrictive procedures, increasing to 75 % with combined restrictive-malabsorptive methods. All weight-loss methods offer a considerable improvement or even elimination of obesity-related co-morbidities and substantially improvement of quality of life. Well-documented, long-term studies reveal a perioperative mortality of 0.2–1.0 %, dependent on the surgeon’s experience, and a maximum perioperative morbidity of 20 %. Bariatric surgery is accepted as evidence based, safe and effective treatment of obesity.

Schlüsselwörter

Adipositaschirurgie - bariatrische Chirurgie - Magenband - Magenbypass

Keywords

Obesity surgery - bariatric surgery - gastric banding - gastric bypass

• Literatur

• 1 Deurenberg-Yap M, Chew SK, Deurenbeg P. Elevated body fat percentage and cardiovascular risks at low body mass index in Singaporean Chinese, Malays and Indians. Obes Rev 2002; 03: 209-215.
• 2 Deitel M. Overweight and obesity worldwide now estimated to involve 1.7 billion people (Editorial). Obes Surg 2003; 13: 329-330.
• 3 Worldwatch Institute. http://www.worldwatch.org. (referred to: September 9, 2002).
• 4 Clarke WR, Lauer RM. Does childhood obesity track into adulthood?. Critical Reviews in Food, Science and Nutrition 1993; 33 (4/5): 423-430.
• 5 Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children 1990–2000. JAMA 2002; 288: 1728-1732.
• 6 Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999–2000. JAMA 2002; 288: 1723-1727.
• 7 Sturm R. Increases in clinically severe obesity in the United States, 1986–2000. Arch Intern Med 2003; 163: 2146-2148.
• 8 Deitel M. Diet, physical activity and health – EU Platform for Action. Europa Newsletter 2005; 53.
• 9 Deitel M. Healthy throughout life. Danish National Board of Health. 2003
• 10 Keller U. Genetik der Adipositas. Kleine Ursache – Große Wirkung. Cardiovasc 2004; 21-24.
• 11 Branson R, Potoczna N, Kral JG. et al. Binge eating as a major phenotype of melanocortin 4 receptor gene mutations. N Engl Med 2003; 348 (12) 1096-1103.
• 12 Kalra SP, Kalra PS. Neuropeptide Y. a physiological orexigen modulated by the feedback action of ghrelin and Leptin Endocrine 2003; 22 (01) 49-56.
• 13 Wynne K, Stanley S, McGowan B, Bloom S. Appetite control. J Endo 2005; 184 (02) 291-318.
• 14 Dina C, Meyre D, Gallina S. et al. Variation in FTO contributes to childhood obesity and severe adult obesity. Nat Genet 2007; 39 (06) 724-726 Epub 2007 May 13.
• 15 Fontaine KR, Redden DT, Wang C. et al. Years of Life lost due to obesity. JAMA 2003; 289: 187-191.
• 16 Calle EE, Rodriguez C, Walker KA. et al. Overweight, obesity and mortality from cancer in a prospective studied cohort of us Adults. N Engl J Med 2003; 348: 1625-1631.
• 17 Wadden Th, Stunkard AJ. “Social and Psychological Consequences of Obesity”. Ann of Internal Medicine 1985; 103: 1062-1067.
• 18 Neel JV. Diabetes mellitus: A “thrifty” genotype rendoed detrimental by “progress”? Am J. Hum Gen 1962; 14L: 353-362.
• 19 Cumming DE, Schwartz MW. Genetics and pathophysiology at human obesity. Ann u Rev Med 2003; 54: 453-471.
• 20 Sjöström L, Rissanen A, Andersen T. et al. Randomized placebo-controlled trial of Orlistat for weight loss and prevention of weight regain in obese patients. Lancet 1998; 352: 167-172.
• 21 Sjöström CD. Surgery as an intervention for obesity. Results from the Swedish obese subjects study. Growth Hormone IGF Research 2003; 13: 522-526.
• 22 Buchwald H, Avidor Y, Braunwald E. et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292: 1724-1737.
• 23 Sjöström L. Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery. The New England Journal of Medicine 2004; 26.
• 24 NIH consensus conference Statement. Bariatric surgery for morbid obesity: Health implications for patients, health professionals and third-party payers. J Ann Coll Surg 2005; 20: 593-604.
• 25 Christou NV, Sampalis JS, Liberman M. et al. Surgery decreases long-term mortality in morbidly obese patients. Ann Surg 2004; 240: 416-424.
• 26 Sampalis JS, Liberman M, Auger S, Christou NV. The impact of weight reductions on health care costs in morbidly obese patients. Obes Surg 2004; 14: 939-947.
• 27 Sjöström L, Narbro K, Sjöström CD. et al. Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357 (08) 741-752.
• 28 Capella J, Capella R. Bariatric Surgery in Adolescence. Is this the best Age to operate? Obesity Surgery 2003; 13 (06) 826-837.
• 29 Breaux CW. Obesity Surgery in children. Obesity Surgery 1995; 05 (03) 279-284.
• 30 Sugerman HJ, De Maria EJ, Kellum JM. Bariatric Surgery for severely obese Adolescents. Journal of Gastrointestinal Surgery 2003; 07 (01) 102-108.
• 31 Inge TH, Krebs NF, Garcia VF. et al. Bariatric Surgery for severly overweight adolescents: concerns and recommendations. Pediatrics 2004; 114 (01) 217-223.
• 32 Fried M, Hainer V, Basdevant A. et al. Inter-Disciplinary European guidelines on surgery of severe obesity. Int J Obes 2007; 31 (04) 569-577.
• 33 Rand CS, Macgregor AM. Age, Obesity Surgery and Weight loss. Obes Surg 1991; 01 (01) 47-49.
• 34 Rössner. Obesity in the elderly – a future matter of concens?. Obesity Reviews 2001; 02 (13) 183-188.
• 35 Branson R, Potoczna N, Brunotte R. et al. Impact of Age, Sex and BMI on Outcomes at Four Years after Gastric Banding. Obes Surg 2005; 15 (06) 834-842.
• 36 Sheiner E, Levy A, Silverberg D. et al. Pregnancy after bariatric surgery is not associated with adverse perinatal outcome. Ann. J. Obbslet Gynecal 2004; 190 (05) 1335-1340.
• 37 Kral JG, Biron S, Simard S. et al. Large maternal weight loss from obesity surgery prevents transmission of obesity to children who were followed for 2 to 18 years. Pedriatrics 2006; 118 (06) 1644-1649.
• 38 Nguyen NT. Laparoscopic versus open gastric bypass: a randomized study of outcomes, quality of life and costs. Ann Surg 2001; 234 (03) 279-291.
• 39 Lujan JA, Frutos MD, Hernandez Q. et al. Laparoscopic versus open gastric bypass in the treatment of morbid obesity: a randomized prospective study. Ann Surg 2004; 239 (04) 433-437.
• 40 Potoczna N, Krech Th, Horber FF. Vitamin and iron metabolism in morbid obese patients before and after adjustable gastric band implantation. Presented to the European Study of Parenteral and Enteral Nutrition 2002, Glasgow. Clin Nutr 2002; 21 (Suppl. 01) 49-50.
• 41 Steffen R, Biertho L, Ricklin T. et al. Laparoscopic Swedish Adjustable Gastric Banding: a Five-Year Prospective Study. Obesity Surgery 2003; 13: 404-411.
• 42 Moorehead MK, Ardelt-Gattinger E, Lechner H, Oria HE. The validation of the Moorehead-Ardelt Quality of Life Questionnaire II. Obes Surg 2003; 13 (05) 684-692.
• 43 Singh S, Kumar A. Wernicke encephalopathy after obesity surgery: a systematic review. Neurology 2007; 68 (11) 807-811.
• 44 Infanger D, Baldinger R, Branson R. et al. Effect of significant intermediate-term weight loss on serum leptin levels and body composition in severely obese subjects. Obes Surg 2003; 13 (06) 879-888.
• 45 Cummings DE, Overduin J, Shannon MH, Foster-Schubert KE. 2004 ABS Consensus Conference. Hormonal mechanisms of weight loss and diabetes resolution after bariatric surgery. Surg Obes Relat Dis 2005; 01 (03) 358-368.
• 46 Schneider H, Schmid A. Die Kosten der Adipositas in der Schweiz Schlussbericht. Für das Bundesamt für Gesundheit (BAG) Bern, Schweiz, 29. April 2004.