Operative Techniken und deren Outcome in der metabolischen Chirurgie: Sleeve-Gastrektomie

Zusammenfassung

Die laparoskopische Schlauchmagenoperation (Sleeve-Gastrektomie; LSG) erfährt derzeit eine rasche Verbreitung als bariatrischer Eingriff. Ursprünglich war die Sleeve-Gastrektomie als ­erster Teileingriff eines 2-Stufenkonzepts zur Risikosenkung bei extremer Adipositas vorgeschaltet worden. Bereits viele Jahre zuvor war eine sehr ähnliche Operation, die „Magenstrasse & Mill“ (M & M)-Operation als eine „physiologischere“ bariatrische Operation (Magenteilung mit Antrumerhalt ohne Resektion) mit dem Ziel der Vermeidung von Implantatkomplikationen (z. B. Magenband) sowie metabolischer Langzeitkomplikationen (Bypass) entwickelt worden. Die Ergebnisse waren nach entsprechender Modifikation auch im 5-Jahres-Verlauf mit akzeptablem Gewichtsverlust ohne Probleme mit Dump­ing, Diarrhö etc. überzeugend. Die nachfolgende Arbeit analysiert die aktu­elle Literatur anhand einer Medline-Recherche sowie die eigenen Frühergebnisse an inzwischen 40 LSG-Patienten. Zudem werden Parallelen zur M & M-Operation herausgearbeitet. Derzeit werden zahlreiche Modi­fikationen unter ­anderem in Bezug auf den Durchmesser, das Magen­restvolumen und die Staplertechnik mitgeteilt. Morbidität und Leta­lität sind vergleichbar mit Magenband- und Magen­bypassoperationen. Die aktuellen ­Daten belegen eine dem Roux-Y-Magen­bypass (RYGB) vergleichbare Effektivität in Bezug auf den Gewichts­verlust sowie eine dem Magen­band überlegene Kontrolle von Hunger- und Sättigungs­gefühl in ­einem 3-Jahres-Zeitraum. ­Zusammenfassend darf die laparoskopische Schlauchmagenoperation heute als ein effektiver Standardeingriff zur Therapie der Adipositas ­angesehen werden.

Abstract

Laparoscopic sleeve gastrectomy (LSG) was initially introduced for super-obese patients in a two-step concept in order to reduce the perioper­ative risk. Many years before a very similary technique – the Magenstrasse and Mill (M & M) operation – was developed by Johnston in Leeds / UK as a “more physiological” bariatric procedure with acceptable weight loss, while preserving gastric emptying mechanisms and thus minimising possible side-effects such as vomiting, dumping and diarrhoea, which are common complications of gastric bypass procedures. The following manu­script analyses the current literature and our own preliminary results and parallels publica­tions of the M & M procedure. Until now numerous modifications (e. g., bougie size and residual volume, stapler technique, use of buttress mate­rial) have been reported. However, reported ­morbidity and mortality rates were equal to those of gastric banding and gastric bypass (RYGB). In conclusion, laparoscopic sleeve gastrectomy (LSG) has now proven to be as effective as the RYGB for weight loss over a three-year period. Control of hunger and feeling of fullness are ­reported to be superior compared to gastric band­ing. Laparoscopic sleeve gastrectomy is no longer an experimental procedure. It should be accepted as one of the effective standard procedures for surgical treatment of morbid obesity.

Schlüsselwörter

Schlauchmagen - Sleeve-Gastrektomie - Adipositaschirurgie - Adipositas - Magenstrasse & Mill-Operation - vertikale Gastroplastik

Key words

sleeve gastrectomy - vertical gastrectomy - bariatric surgery - morbid obesity - Magenstrasse and Mill procedure - gastroplasty

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