Bariatrische Chirurgie

Abstract

In the case of obese type-2 diabetics, diabetes remission rates of up to 80% can be achieved by surgical procedures. The S3 guideline recommends four surgical approaches: Roux-en-Y gastric bypass, sleeve gastrectomy, gastric banding and biliopancreatic diversion with duodenal switch (BPD-DS). The surgical indication is made when conservative therapies have failed.Surgical success, mortality, and morbidity depend on the surgeon’s level of experience and the choice of procedure. The highest complication rate is seen with the BPD-DS, although this can be reduced by using a two-staged approach. Long-term observation also highlighted the superiority of surgical approaches to conservative therapy. The mortality risk associated with both obesity-related complications and cancer can be significantly reduced with obesity surgery. Body weight is reduced, life expectancy increased and quality of life improved. Furthermore, these procedures are cost-effective. Therefore, US diabetologists recommend surgery as a therapy option in diabetes patients with a BMI over 35 kg/m 2 . A sharp rise in the number of these surgical procedures can therefore be expected. High-risk patients require professional interdisciplinary peri- and postoperative care; to this end, improved infrastructure with outpatient follow-up concepts in specialized practices is necessary.