Metabolische Chirurgie

Zusammenfassung

Adipositaschirurgie ist die effektivste und langfristig wirksamste Maßnahme in der Behandlung der krankhaften Adipositas (Grad 3) und vieler ihrer Folgeerkrankungen. Eine neue Evidenzlage zeigt, dass die operativen Maßnahmen auch eine Effektivität in der Behandlung des metabolischen Syndroms, einschließlich des Diabetes mellitus Typ 2, der Hypertonie, der Cholesterinerhöhung, der nicht-alkoholischen Lebererkrankungen und der Schlafapnoe aufweisen. Die Chirurgie der Adipositas geht weit über den Gewichtsverlust hinaus. Die chirurgischen Maßnahmen können zur Therapiefreiheit für einen Patienten mit einem Diabetes Typ 2 über einen langen Zeitraum bis zu 2 Dekaden bei den meisten der Patienten beitragen.

Der Begriff “metabolische Chirurgie” wurde von H. Buchwald bereits 1970 geschaffen und basiert auf der POSCH-Studie. Die Ergebnisse der Chirurgie bei der Beeinflussung des metabolischen Syndroms haben dazu beigetragen, dass dieser Begriff auf die Praxis der Adipositaschirurgie übertragen wurde. Es kann erwartet werden, dass die metabolische Chirurgie eine zunehmende Bedeutung im Management dieser Erkrankungen erlangen wird.

Neueste Forschungsergebnisse zeigen, dass die metabolische Chirurgie die Insulinresistenz und -sekretion unabhängig vom Gewichtsverlust durch eine Beeinflussung gastrointestinaler Hormone und anderer Mechanismen verbessern kann. Viele Patienten mit einem Diabetes mellitus Typ 2 zeigen eine komplette Remission der Erkrankung wenige Tage nach der metabolischen Chirurgie, noch lange bevor ein signifikanter Gewichtsverlust eingetreten ist. Diese Tatsache führt zu einem neuen Ansatz, die metabolische Chirurgie auch für solche Diabetiker einzusetzen, die noch normal- und übergewichtig sind.

Summary

Bariatric surgery is known to be the most effective and long lasting treatment for morbid obesity and many related conditions, but now mounting evidence suggests it may be among the most effective treatments for metabolic diseases and conditions including type 2 diabetes, hypertension, high cholesterol, non-alcoholic fatty liver disease and obstructive sleep apnoea. Surgery for severe obesity goes way beyond weight loss. This surgery results in the complete remission (no need of pharmacological treatment) or significant improvement of type 2 diabetes and other lifethreatening diseases in most patients.

The term “metabolic surgery” was introduced by H. Buchwald during the POSCH-study in the 70ties and mission reflects this expanded and evolving view of surgery. The efficacy of surgical procedures on the metabolic syndrome was the background for the use of the item “metabolic surgery” in the field of obesity surgery.Therefore we expect metabolic surgery to play an ever increasing role in managing these diseases.

New research results indicate that metabolic surgery may improve insulin resistance and secretion by mechanisms independent of weight loss – most likely involving changes in gastrointestinal hormones. Many patients with type 2 diabetes experience complete remission within days of metabolic surgery, long before significant weight comes off. This has led to new thinking that metabolic surgery may also be appropriate for diabetic individuals who are of normal weight or only slightly overweight.

Schlüsselwörter

Adipositas - metabolische Chirurgie - Diabetes mellitus Typ 2 - metabolisches Syndrom

Keywords

Obesity - metabolic surgery - diabetes mellitus type 2 - metabolic syndrome

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