Therapieoptionen bei Weight-Regain nach Bariatrischer Operation

Zusammenfassung

Hintergrund Die Intention dieses Artikels ist, einen Überblick über die Diagnosestellung und Therapiemöglichkeiten bei erneuter Gewichtszunahme (WR) oder unzureichendem Gewichtsverlust (IWL) nach bariatrischer Operation (BS) zu geben. Bei weiter steigenden Zahlen der BS gewinnt WR immer mehr an Relevanz.

Methoden Eine ausgiebige Literaturrecherche wurde mit persönlichen Erfahrungen kombiniert, um eine mögliche Handlungsempfehlung bei WR oder IWL zu geben.

Ergebnisse Im Falle einer anatomischen Ursache für WR ist der chirurgische Therapieansatz derzeit am effektivsten. Bei idiopathischem WR oder IWL ist ein multimodales Therapiekonzept für eine erfolgreiche Therapie notwendig. Abhängig von der vorangegangenen OP ist eine Kombination von Lebensstilinterventionen, medikamentöser und chirurgischer Therapie ein wirksames Vorgehen.

Schlussfolgerungen Eine ausgiebige Diagnostik ist vor Indikationsstellung einer chirurgischen Revision notwendig. Bei idiopathischem WR und IWL nach Roux-Y-Magenbypass (RYGB) schlagen wir die Verlängerung des biliopankreatischen Schenkels bei gleichzeitiger Verkürzung des Common Channels vor. Nach Schlauchmagen (Sleeve-Gastrektomie, SG) sehen wir derzeit die Umwandlung in RYGB bei Patienten mit gleichzeitiger Refluxösophagitis und den SADI-S bei fehlendem Vorliegen eines Refluxes als sinnvollste Therapie an.

Abstract

Purpose The purpose of this article is to create an overview of diagnostic and therapeutic options for weight regain (WR) and insufficient weight loss (IWL) after bariatric surgery (BS). With increasing popularity of BS, WR is becoming more relevant.

Methods We combined recent literature on WR and IWL with personal experience to suggest possible proceedings if WR or IWL is diagnosed.

Results If an anatomical-pathological cause can be detected, surgical therapy is the most effective. If WR or IWL is idiopathic, a multimodal therapeutic concept is necessary for sufficient therapeutic success. Depending on the initial BS, a combination of lifestyle intervention, medication and surgical therapy seems most effective.

Conclusions Extensive diagnostic testing is necessary prior to any surgical intervention. In idiopathic WR after Roux-en-Y Gastric Bypass (RYGB), we suggest lengthening the biliopancreatic limb and shortening the common channel. After Sleeve-Gastrectomy (SG), we currently see RYGB as most effective in patients with gastroesophageal reflux disease (GERD) and SADI-S as a feasible option if no GERD is present.

Schlüsselwörter

Schlauchmagen - Roux-Y Magenbypass - OAGB - Gewichtszunahme - SADI

Keywords

RYGB - sleeve gastrectomy - OAGB - insufficient weight loss - SADI

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