The 6th Frankfurt Meeting for Surgery of Obesity and Metabolic Disorders

Abstract

12 years after the first scientific meeting to the topic ‘Surgery for Morbid Obesity’ in Germany, the 5th Frankfurt meeting in 2008 extended the main topics surgery and obesity into ‘Obesity and Metabolic Surgery’. Between 2002 and 2009, the meeting took place in the old town hall of Frankfurt, called Romer since centuries, which contributed to the special and familiar atmosphere. All lectures were presented in the plenary session room of the Parliament of Frankfurt am Main, but with the increasing interest in the field, the town hall became too small. Therefore, the 6th Frankfurt meeting changed the location from the town hall to the congress palace in 2010. 540 experts in the field, more than initially expected, came and took part in the different sessions and workshops. The congress offered a comprehensive overview of the latest advances, breakthroughs and novelties in the minimally invasive treatment of this fatal modern age epidemic. At the one end of the malnutrition scale, obesity is one of today’s most blatantly visible – yet most neglected – public health problems. Paradoxically coexisting with malnutrition, an escalating global epidemic of overweight and obesity – ‘globesity’ – spread over many parts of the world. If no immediate action takes place, millions will suffer from an considerable number of serious health disorders. Obesity is a complex condition with serious social and psychological dimensions that affects virtually all age and socioeconomic groups and threatens to overwhelm both developed and developing countries. In 1995 there were an estimated 200 million obese adults worldwide and another 18 million children under the age of 5 that were classified as overweight. As of 2000 the number of obese adults has increased to over 300 million. Contrary to common expectations, the obesity epidemic is not restricted to industrialized societies. It is estimated that in developing countries over 115 million people suffer from obesity-related problems. As commonly known, obesity surgery is the only effective strategy to treat severely obese patients. Obesity treatment should be individually tailored, and all crucial factors, such as sex, the degree of obesity, individual health risks as well as psychobehavioral and metabolic characteristics, should be taken into account. The spectrum of the procedures in obesity surgery is subject to continuous change and improvement. During the last 2 years, laparoscopic sleeve gastrectomy (LSG) increasingly has attracted the attention of surgeons and patients. LSG is an effective first line operation to achieve definitive weight loss in suitable patients and is also applied as revision treatment if other surgical interventions did not succeed. Its advantages are that i) it is not as technically difficult as the laparoscopic biliopancreatic diversion duodenal switch, ii) it can lead to very good weight loss results in the medium term and iii) it can help to reverse co-morbidities, thereby further improving patient’s health as well as lessening the risk if further surgical weight loss interventions should be necessary. LSG also has a strong short-term effect on the metabolic syndrome but, when compared with gastric bypass surgery, weight regain results in an earlier recurrence of the diabetes situation. Because LSG is a restrictive rather than a malabsorptive procedure, nutritional concerns are much less than with bypass surgeries. However, the quality control study in Germany showed that this type of surgery is accompanied by more major complications and a higher mortality than the gastric bypass intervention in experienced hands. The Achilles heel of LSG is still the staple line leak in the angle of His. Therefore, also another surgical weight loss intervention, namely gastroplication, attracts more and more attention. With this procedure the risk of leaks is nonexisting, and the procedure can be performed endoscopically. The mechanism of restriction seems to be comparable with that of sleeve gastrectomy.