Erschienen in:
01.12.2003 | Current Concepts in Clinical Surgery
Open-surgery management of morbid obesity: old experience–new techniques
verfasst von:
Bernhard Husemann
Erschienen in:
Langenbeck's Archives of Surgery
|
Ausgabe 6/2003
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Abstract
Bariatric surgery is well established to treat morbidly obese patients (BMI >40 kg/m2) with various techniques. Gastric-restriction procedures [adjustable gastric band, vertical banded gastroplasty (VBG)] reduce caloric intake and are well accepted (weight loss up to BMI 28–33 kg/m2 after 5 years), but they are less effective in super-obese patients and in sweet-eaters. For that group combined techniques, such as duodenal switch, gastric bypass or bilio-pancreatic diversion, could produce a better weight loss (between 60 and 160 kg or BMI of 25–30 kg/m2) with acceptable long-term side effect; however, due to malabsorption, a lack of minerals and vitamins, even protein, could occur and have dangerous side effects. Both basic techniques have their place in the treatment of morbid obesity. The surgical approach—open or mini-invasive—is only of minor importance. Technical complications should be avoided, especially band dislocation (2–12%) or suture leak. Long-term follow-up is very important because obesity is a chronic disease with a high risk of recurrence, even after bariatric surgery.