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Adipositas - Ursachen, Folgeerkrankungen, Therapie 2011; 05(01): 37-45
DOI: 10.1055/s-0037-1618730
Serie Adipositaschirurgie
Schattauer GmbH

Operative Verfahren zur Behandlung der morbiden Adipositas

Indikationen, Verfahren und GrenzenSurgical treatment of morbid obesityIndications, procedures and limits
T. Hasenberg
1   Chirurgische Klinik, Universitätsmedizin Mannheim
,
E. Shang
2   Department für Operative Medizin, Sektion Bariatrische Chirurgie, Klinik und Poliklinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinik Leipzig
› Author Affiliations
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Publication History

Publication Date:
22 December 2017 (online)

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Zusammenfassung

In Deutschland haben 20 % der Männer und 21,1 % der Frauen einen BMI über 30. Geschätzte 1,02 Millionen erwachsene Männer und Frauen in Deutschland sind morbid adipös (BMI >40). Diese Verbreitung der Adipositas und vor allem der morbiden Adipositas in Deutschland ist mit der Adipositasinzidenz in Nordamerika vergleichbar. Die bisherigen, konservativen Adipositas-Therapiekonzepte mit langfristigen Erfolgsraten von unter 1–2 % versprechen keine Entspannung dieser Situation. Nachhaltige und flächendeckende Präventionsprogramme sind ebenfalls nicht in Sicht. Die derzeit einzige, auch langfristige, Therapie gegen die morbide Adipositas ist die Adipositaschirurgie, auch Bariatrische Chirurgie genannt. Im Kampf gegen die morbide Adipositas stehen ganz unterschiedliche operative Maßnahmen zur Verfügung. Grundsätzlich können restriktive (Magenband, Magenschlauch) und kombiniert restriktiv und malabsorptive Verfahren (Roux-Y-Magenbypass, Bilio-Pankreatische Diversion) unterschieden werden. Neben einem Verlust von bis zu 75–80 % des Übergewichts stehen vor allem auch die Remissionsraten der Begleiterkrankungen, wie Diabetes mellitus Typ 2 oder das metabolische Syndrom, im Vordergrund. So kann die deutlich reduzierte Lebenserwartung morbid Adipöser an die von Normalgewichtigen angeglichen werden. Nachfolgend werden Möglichkeiten und Grenzen der bariatrischen Chirurgie zum aktuellen Zeitpunkt dargestellt.

Summary

In Germany 20 % of the male and 21.1 % of the female adults are presenting a BMI of more than 30 kg/m2. 1.02 Million of the adults in Germany are morbidly obese (BMI >40 kg/m2).This pandemic situation of obesity and morbid obesity is similar to the incidence of obesity in North America. In consideration of the increasing obesity incidence the longterm success rate of the conservative obesity treatment of 1–2 % does not ease this situation. Area wide prevention programs are not in planning. The actual only as well long term effective therapy against morbid obesity is bariatric surgery. There is an arsenal of restrictive (gastric band, gastric sleeve) and combinations of restrictive and malabsorptive procedures (Roux-en-Y gastric bypass, biliopancreatic diversion) available to treat morbid obesity. Bariatric surgery can not only induce excess weight loss of 75–80 % as well as a remission of co-morbidities like type 2 diabetes mellitus or the metabolic syndrome. Even the tremendous reduced life expectancy of morbid obese patients could be adapted to normal weighted subjects by bariatric surgery. The following overview should present the impact and the borders of bariatric surgery at the current evidence.

Schlüsselwörter

Bariatrische Chirurgie - metabolische Chirurgie - morbide Adipositas - adipositas-assoziierte Ko-Morbiditäten

Keywords

Bariatric Surgery - metabolic surgery - morbid obesity - obesity-associated co-morbidities
 

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