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Wird die laparoskopische Sleeve-Gastrektomie als „Stand-alone“-Verfahren weiter existieren?

Ein prozedurenkritischer Ausblick

Will laparoscopic sleeve gastrectomy continue to exist as a stand-alone procedure?

A procedure critical perspective

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Zusammenfassung

Hintergrund

Die Sleeve-Gastrektomie ist die derzeit weltweit am häufigsten durchgeführte bariatrische Operation. Bezüglich eventuell notwendiger Umwandlungsoperationen im Verlauf (insbesondere wegen Refluxerkrankung oder Gewichtswiederzunahme) wird jedoch eine zunehmend kontroverse Diskussion bezüglich der Indikationsstellung geführt.

Fragestellung

Es soll kritisch diskutiert werden, ob die Sleeve-Gastrektomie weiter als „Stand-alone“-Verfahren Bestand haben wird.

Material und Methode

Es erfolgte eine Auswertung und Diskussion der aktuellen Literatur bezüglich der Ergebnisse nach Sleeve-Gastrektomie und daraus postulierter Empfehlungen.

Ergebnisse

Die Sleeve-Gastrektomie macht inzwischen ca. 50 % aller aktuell durchgeführten adipositaschirurgischen Primäreingriffe aus und hat sich als solitäres Verfahren etabliert. Sie führt mittelfristig zu guten Ergebnissen, verglichen mit dem proximalen Roux-en-Y-Magenbypass ist sie diesem jedoch bezüglich der Remission eines vorbestehenden Typ-2-Diabetes, der Kontrolle einer Refluxerkrankung und auch bezüglich der Gewichtsreduktion unterlegen. Bei gleicher Mortalität ist die Morbidität geringer, zu beachten ist jedoch die relevante Rate an Fisteln der Klammernaht.

Schlussfolgerungen

Patienten, denen eine Sleeve-Gastrektomie angeboten wird, muss erläutert werden, dass in einem noch nicht abschätzbaren Prozentsatz eine Umwandlungs- oder ReDo-Operation erforderlich werden kann. Diese kann im Wesentlichen bedingt sein durch eine Gewichtswiederzunahme bzw. das Nichterreichen des individuellen Therapieziels oder durch eine Verschlechterung einer vorbestehenden oder De-novo-Refluxerkrankung.

Abstract

Background

Sleeve gastrectomy is currently the most frequently performed bariatric procedure worldwide; however, with respect to a certain need for revisional surgery (due to reflux disease or weight regain) there is an ongoing discussion about the value of sleeve gastrectomy in terms of a stand-alone procedure.

Objective

The aim of this article is to critically discuss whether sleeve gastrectomy can still be considered a stand-alone procedure.

Material and methods

The current literature was searched for results after sleeve gastrectomy and the recommendations regarding this procedure are discussed.

Results

Currently approximately 50% of primary bariatric procedures are sleeve gastrectomies, which has become a well-established stand-alone procedure. Sleeve gastrectomy leads to good mid-term results; however, the results of the Roux-en-Y gastric bypass are comparatively superior in terms of type 2 diabetes remission, control of preexisting or de novo reflux disease and weight loss. The mortality is comparable; however, the morbidity is lower after sleeve gastrectomy but there is a relevant rate of fistulas of the stapler suture.

Conclusion

Patients considered for sleeve gastrectomy must be informed of the procedure-specific risks, including the unforeseeable need for revision or redo surgery firstly due to weight regain or failing to reach the individual therapy target and secondly for worsening of a preexisting or de novo reflux disease.

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Authors and Affiliations

  1. Klinik u. Poliklinik für Visceral‑, Transplantations‑, Thorax- u. Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    A. Dietrich

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A. Dietrich gibt an, dass kein Interessenkonflikt besteht.

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

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Dietrich, A. Wird die laparoskopische Sleeve-Gastrektomie als „Stand-alone“-Verfahren weiter existieren?. Chirurg 89, 583–588 (2018). https://doi.org/10.1007/s00104-018-0680-8

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