Zusammenfassung
Die metabolische Wirkung bariatrischer Operationen ist bekannt und bei Patienten mit Adipositas Grad III (BMI > 40 kg/m2) als evident zu betrachten. In den letzten Jahren wurden metabolische Operationen zunehmend bei Patienten mit Adipositas Grad II (BMI 35–40 kg/m2) und Adipositas Grad I (BMI 30–35 kg/m2) durchgeführt. Die Indikation für metabolische Operationen bei Adipositas Grad I ist aufgrund der bis zuletzt unzureichenden Datenlage Gegenstand aktueller Diskussionen. In den letzten 5 Jahren wurden allerdings einige methodisch hochwertige klinische randomisiert kontrollierte Studien veröffentlicht, die eine Bewertung der Wirksamkeit metabolischer Operationen im Vergleich zur konservativen Therapie bei Adipositas Grad I ermöglichen. Auf Grundlage dieser Daten kann die Effizienz der metabolischen Chirurgie im Vergleich zur leitliniengerechten konservativen Therapie im kurzfristigen Follow-up (12–36 Monate) für Patienten mit Adipositas Grad I und II als gesichert betrachtet werden. Neben einer verbesserten glykämischen Kontrolle und einer Remission des Diabetes haben metabolische Eingriffe auch das Potenzial, Diabetes-assoziierte Folgeerkrankungen wie die diabetische Retinopathie, Nephropathie und Polyneuropathie und Komorbiditäten wie arterielle Hypertonie und Dyslipidämie positiv zu beeinflussen. Zukünftige klinische kontrollierte Studien sollten die langfristige Wirkung der metabolischen Chirurgie (> 36 Monate), die Patientenselektion und die Verfahrenswahl adressieren.
Abstract
The metabolic effect of bariatric surgery is well-established and is considered to be self-evident in morbidly obese patients with a body mass index (BMI) > 40 kg/m2. Metabolic surgery performed on patients with obesity grades II (BMI 35–40 kg/m2) and I (BMI 30–35 kg/m2) according to the World Health Organization (WHO) has increased in recent years; however, the indications for metabolic surgery in obesity grades I and II are currently under debate due to insufficient evidence. In the last 5 years several highly qualified randomized clinical trials have been published which evaluated the effect of metabolic surgery in patients with obesity grades I and II in comparison to conservative therapy. Based on these data the efficacy of metabolic surgery in short-term follow-up (12–36 months) is unquestionable when compared to conservative therapy according to the current guidelines. Besides improved glycemic control and remission of diabetes, metabolic surgery has the potential to have a positive influence on diabetic complications, such as diabetic retinopathy, nephropathy and polyneuropathy, as well as on comorbidities, such as arterial hypertension and dyslipidemia. Future clinical trials should address the long-term (> 36 months) effects of metabolic surgery, patient selection criteria and choice of procedure.
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Interessenkonflikt. J.D. Senft, A.T. Billeter, L. Fischer und BP. Müller-Stich geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
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Senft, J., Billeter, A., Fischer, L. et al. Klinische Evidenz der metabolischen Chirurgie. Chirurg 85, 952–956 (2014). https://doi.org/10.1007/s00104-014-2797-8
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DOI: https://doi.org/10.1007/s00104-014-2797-8