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Der Chirurg

, Volume 90, Issue 2, pp 157–170 | Cite as

Metabolische Chirurgie

  • A. T. Billeter
  • B. P. Müller-StichEmail author
CME
  • 46 Downloads

Zusammenfassung

Die chirurgische Therapie metabolischer Erkrankungen hat sich in den letzten Jahren als effektive Alternative zur konservativen Therapie etabliert. Die neuen S3-Leitlinien adressieren diese Veränderungen und geben klare Indikationen für die Adipositaschirurgie. Einer der Kernpunkte der neuen Leitlinien stellt die Unterscheidung der Adipositaschirurgie von der metabolischen Chirurgie dar. Bei der Adipositaschirurgie ist der Gewichtsverlust das primäre Therapieziel, während es bei den metabolischen Indikationen die Verbesserung der Komorbidität unabhängig vom BMI ist. Bezüglich der Verfahrensauswahl können die SG und der traditionelle RYGB als sichere und mit harter Evidenz belegte Operationen angewandt werden. Der RYGB hat bessere metabolische Effekte bei jedoch auch höheren Komplikations- und Reinterventionsraten. Neuere Verfahren wie der „one anastomosis gastric bypass“ oder der „single anastomosis duodeno-ileal“ haben möglicherweise leicht stärkere metabolische Effekte, wobei allerdings auch das Risiko für Mangelernährung und Vitaminmängel höher ist.

Schlüsselwörter

Diabetes mellitus Bariatrische Chirurgie Mikrovaskuläre Komplikationen Makrovaskuläre Komplikationen Nichtalkoholische Fettlebererkrankung 

Metabolic surgery

Abstract

In recent years the surgical treatment of metabolic diseases has become established as an effective alternative to conservative treatment. The new S3 guidelines address these changes and give clear indications for obesity surgery. One of the core points of the new guidelines is the differentiation between obesity surgery and metabolic surgery. In obesity surgery the primary aim of treatment is weight loss whereas for metabolic indications the aim is an improvement of comorbidities independent of the body mass index (BMI). With respect to the selection of procedures sleeve gastrectomy (SG) and the traditional Roux-en-Y gastric bypass (RYGB) can be used as safe and evidence-based operative procedures. The RYGB has better metabolic effects but higher complication and reintervention rates. More recent procedures, such as the one anastomosis gastric bypass (OAGB) and single anastomosis duodeno-ileal (SADI) bypass possibly have slightly stronger metabolic effects, however, the risk of malnutrition and vitamin deficiency is higher.

Keywords

Diabetes mellitus Bariatric surgery Microvascular complications Macrovascular complications Nonalcoholic fatty liver disease 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

A. T. Billeter und B. P. Müller-Stich geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Allgemein‑, Viszeral- und TransplantationschirurgieUniversitätsklinik HeidelbergHeidelbergDeutschland

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