Zusammenfassung
GRUNDLAGEN: Die morbide Adipositas trifft in den Vereinigten Staaten bei mehr als 60 % der Erwachsenen mit Übergewicht zu und hat somit ein epidemisches Ausmaß eingenommen. Die konservativmedizinischen Therapieoptionen wie kalorienarme Diät, Bewegungsübungen, Verhaltensanpassung und medikamentöse Therapie versagen jedoch sehr oft. Die verschiedenen chirurgischen Therapieoptionen scheinen einen längerfristig anhaltenden Gewichtsverlust erzielen zu können. Dies hat in den letzten Jahren zu einem dramatischen Anstieg der Patienten geführt, die sich einer bariatrischen Operation unterzogen haben. METHODIK: Mit Hilfe der Medline-Suche wurde eine Durchsicht der englischsprachigen Literatur über den laparoskopischen Bypass bei morbidem Adipositas durchgeführt. ERGEBNISSE: Die minimal-invasiven Eingriffe haben aufgrund des geringeren postoperativen Schmerzes, der geringeren Wund- und kardiopulmonalen Komplikationen und des schnelleren Erreichens der normalen körperlichen Aktivität zu einer signifikanten Reduktion der perioperativen Morbidität geführt. Die Zahl der Dünndarmobstruktionen beim laparoskopischen Y-Roux Magenbypass scheint höher als bei offener Technik zu sein. Der überwiegend große Teil dieser Komplikationen kann aber wiederum laparoskopisch therapiert werden. Ebenfalls ist die Zahl der Anastomosenstrikturen bei laparoskopisch operierten Patienten höher. Diese Patienten können jedoch endoskopisch behandelt werden und brauchen keine weitere chirurgische Intervention. SCHLUSSFOLGERUNGEN: In USA hat sich der laparoskopische Y-Roux Magenbypass in kurzer Zeit zum Goldstandard der chirurgischen Therapie beim morbiden Adipositas entwickelt. Es konnte dabei auch gezeigt werden, dass der laparoskopische Y-Roux Magenbypass gleich effektiv ist wie der offene Eingriff.
Summary
BACKGROUND: Morbid obesity in the United States has reached epic proportions, with more than 60% of the adult population currently either overweight or obese. Since medical treatment options such as low-calorie diets, exercise programs, behavior modification, and pharmacotherapy often fail, numerous surgical options have been developed which have proved to be effective in achieving long-term maintenance of weight loss. This has resulted in a dramatic increase in the number of patients undergoing bariatric surgery in recent years. METHODS: A review of the English language literature from Medline on laparoscopic gastric bypass for morbid obesity was undertaken. RESULTS: The minimally invasive approach yields significantly decreased perioperative morbidity, principally due to lower postoperative pain, lower rates of wound-related and cardiopulmonary complications, and quicker return to normal activities. Although the rate of small bowel obstruction appears to be higher following Laparoscopic Roux-en-Y gastric bypass (LRYGBP) than following open surgery, the vast majority of these patients can be managed laparoscopically. Additionally, although anastomotic stricture rates are higher following laparoscopic surgery, most of these can be managed endoscopically and do not require further operative procedures. CONCLUSIONS: Laparoscopic Roux-en-Y gastric bypass is quickly becoming the gold standard for surgical treatment of morbid obesity in the United States. The laparoscopic approach has been demonstrated to be as effective as open laparoscopic Roux-en-Y gastric bypass.
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O'Mahony, R., Szomstein, S. & Rosenthal, R. Laparoscopic gastric bypass for morbid obesity. Eur Surg 38, 399–404 (2006). https://doi.org/10.1007/s10353-006-0293-1
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DOI: https://doi.org/10.1007/s10353-006-0293-1