Verfahren und Stellenwert der metabolischen Chirurgie

Kernaussagen

• Übergewichtschirurgische Operationsverfahren zeigen auch bei normalgewichtigen insulinpflichtigen Diabetikern eine signifikante Verbesserung der diabetischen Stoffwechsellage mit einer zunächst kompletten Remission bei weit über 70 % der Patienten.

• Aufgrund erster Daten weisen auch typische diabetesassoziierte Folgeerkrankungen eine Verbesserung in ihrem Verlauf auf.

• Die Langzeitwirkung und Rezidivrate des Diabetes und der diabetesassoziierten Erkrankungen ist noch unklar.

• Die Verfahren der metabolischen Chirurgie und die Nachsorge sind bislang nicht standardisiert.

• Wichtig ist eine lebenslange Nachsorge. Dazu gehören neben der klinischen Untersuchung regelmäßige Blutuntersuchungen zur Statuserhebung des Mineral- und Vitaminhaushalts.

• Literatur

• 1 Sjöström L, Narbro K, Sjöström CD et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357: 741-752
• 2 Adams TD, Gress RE, Smith SC et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 357: 753-761
• 3 Sjöström L, Lindroos A-K, Peltonen M et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004; 351: 2683-2693
• 4 Abbatini F, Capoccia D, Casella G et al. Type 2 diabetes in obese patients with body mass index of 30–35 kg/m²: sleeve gastrectomy versus medical treatment. Surg Obes Relat Dis 2012; 8: 20-24
• 5 Serrot FJ, Dorman RB, Miller CJ et al. Comparative effectiveness of bariatric surgery and nonsurgical therapy in adults with type 2 diabetes mellitus and body mass index < 35 kg/m² . Surgery 2011; 150: 684-691
• 6 Frenken M, Cho EY. Metabolic intestinal bypass surgery for type 2 diabetes in patients with a BMI < 35 kg/m²: comparative analysis of 16 patients undergoing either BPD, BPD-DS, or RYGB. Obes Facts 2011; 4 (Suppl. 01) 13-17
• 7 Bose M, Teixeira J, Olivan B et al. Weight loss and incretin responsiveness improve glucose control independently after gastric bypass surgery. J Diabetes 2010; 2: 47-55
• 8 Ramón JM, Salvans S, Crous X et al. Effect of Roux-en-Y gastric bypass vs sleeve gastrectomy on glucose and gut hormones: a prospective randomised trial. J Gastrointest Surg 2012; 16: 1116-1122
• 9 Mingrone G, Panunzi S, De Gaetano A et al. Bariatric Surgery versus Conventional Medical Therapy for Type 2 Diabetes. N Engl J Med 2012; 366: 1577-1585
• 10 De Paula AL, Stival AR, Macedo A et al. Prospective randomized controlled trial comparing 2 versions of laparoscopic ileal interposition associated with sleeve gastrectomy for patients with type 2 diabetes with BMI 21–34 kg/m² . Surg Obes Relat Dis 2010; 6: 296-304
• 11 Currie CJ, Peters JR, Tynan A et al. Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet 2010; 375: 481-489
• 12 Kumar KVSH, Ugale S, Gupta N et al. Ileal interposition with sleeve gastrectomy for control of type 2 diabetes. Diabetes Technol Ther 2009; 11: 785-789
• 13 Schauer PR, Kashyap SR, Wolski K et al. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med 2012; 366: 1567-1576
• 14 DePaula AL, Macedo ALV, Mota BR et al. Laparoscopic ileal interposition associated to a diverted sleeve gastrectomy is an effective operation for the treatment of type 2 diabetes mellitus patients with BMI 21–29. Surg Endosc 2009; 23: 1313-1320
• 15 Lee W-J, Chong K, Ser KH et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg 2011; 146: 143-148
• 16 Lee W-J, Hur KY, Lakadawala M et al. Gastrointestinal metabolic surgery for the treatment of diabetic patients: a multi-institutional international study. J Gastrointest Surg 2012; 16: 45-51 ; discussion 51-52
• 17 Frenken M, Cho EY, Karcz WK et al. Improvement of type 2 diabetes mellitus in obese and non-obese patients after the duodenal switch operation. J Obes 2011; 2011: 860169
• 18 Gandhi R, Razak F, Tso P et al. Metabolic syndrome and the incidence of symptomatic deep vein thrombosis following total knee arthroplasty. J Rheumatol 2009; 36: 2298-2301
• 19 Parkin L, Sweetland S, Balkwill A et al. Body Mass Index, Surgery, and Risk of Venous Thromboembolism in Middle-Aged Women: A Cohort Study. Circulation 2012; 125: 1897-1904
• 20 Chan MM, Hamza N, Ammori BJ. Duration of surgery independently influences risk of venous thromboembolism after laparoscopic bariatric surgery. Surg Obes Relat Dis 2011; PMID: 22055389
• 21 Buchwald H, Avidor Y, Braunwald E et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292: 1724-1737
• 22 Perugini RA, Mason R, Czerniach DR et al. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients. Arch Surg 2003; 138: 541-545 ; discussion 545-546
• 23 DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med 2007; 356: 2176-2183
• 24 Tack J, Arts J, Caenepeel P et al. Pathophysiology, diagnosis and management of postoperative dumping syndrome. Nat Rev Gastroenterol Hepatol 2009; 6: 583-590
• 25 Abell TL, Minocha A. Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci 2006; 331: 214-218
• 26 Z’graggen K, Guweidhi A, Steffen R et al. Severe recurrent hypoglycemia after gastric bypass surgery. Obes Surg 2008; 18: 981-988
• 27 Mathavan VK, Arregui M, Davis C et al. Management of postgastric bypass noninsulinoma pancreatogenous hypoglycemia. Surg Endosc 2010; 24: 2547-2555
• 28 Fischer L, Hildebrandt C, Bruckner T et al. Excessive Weight Loss after Sleeve Gastrectomy: A Systematic Review. Obesity Surgery 2012; 22: 721-731
• 29 Nocca D, Krawczykowsky D, Bomans B et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg 2008; 18: 560-565
• 30 Fuks D, Verhaeghe P, Brehant O et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery 2009; 145: 106-113
• 31 Skroubis G, Sakellaropoulos G, Pouggouras K et al. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass. Obes Surg 2002; 12: 551-558
• 32 Bloomberg RD, Fleishman A, Nalle JE et al. Nutritional deficiencies following bariatric surgery: what have we learned?. Obes Surg 2005; 15: 145-154
• 33 Vargas-Ruiz AG, Hernández-Rivera G, Herrera MF. Prevalence of iron, folate, and vitamin B12 deficiency anemia after laparoscopic Roux-en-Y gastric bypass. Obes Surg 2008; 18: 288-293
• 34 Coupaye M, Puchaux K, Bogard C et al. Nutritional consequences of adjustable gastric banding and gastric bypass: a 1-year prospective study. Obes Surg 2009; 19: 56-65
• 35 Slater GH, Ren CJ, Siegel N et al. Serum fat-soluble vitamin deficiency and abnormal calcium metabolism after malabsorptive bariatric surgery. J Gastrointest Surg 2004; 8: 48-55 ; discussion 54 – 55
• 36 Tindle HA, Omalu B, Courcoulas A et al. Risk of Suicide after Long-term Follow-up from Bariatric Surgery. The Am J of Medicine 2010; 123: 1036-1042
• 37 Dixon JB, Dixon ME, O’Brien PE. Depression in association with severe obesity. Arch Intern Med 2003; 163: 2058-2065