Bariatric surgery is a branch of the visceral surgery and includes all recognized measures for the control of morbid obesity, including the gastric band, as well as the stomach, the gastric bypass and biliopancreatic diversion with Duodenalswitch fall.

In addition to a body mass index above 40, the prerequisite for an adiposity surgical procedure is the unsuccessful exhaustion of conservative methods for weight loss, but comorbidities and age parameters must also be taken into consideration. The consultation of the patients takes place in specially certified institutions, whereby a competent care is necessary also after the operation, since the patient has to change his diet, for example, in order to be able to profit permanently from the surgical change of his gastrointestinal tract.

What is bariatric surgery?

Bariatric surgery is a branch of the visceral surgery and includes all recognized measures for the control of morbid obesity, including the gastric band, as well as the stomach, the gastric bypass and biliopancreatic diversion with Duodenalswitch fall.

The term bariatric surgery or bariatric surgery covers all surgical interventions to combat pathological obesity. As a specialty of visceral surgery, bariatric surgery is particularly concerned with the gastrointestinal tract. In the course of an adiposity surgical procedure, obesity is counteracted by surgical changes in the gastrointestinal tract.

Thus, bariatric surgery is the most invasive method of weight loss and at the same time helps to minimize the risk of complications. The four accepted standard procedures for this surgical procedure are gastric banding, biliopancreatic diversion with duodenal switch, gastric bypass and gastric tube. While the gastric banding, gastric bypass, and gastric glands on their own limit the maximum intake of food, biliopancreatic diversion with duodenal switch limits the maximum intake of certain dietary ingredients.

Function, effect & goals

The goal of any obesity surgical procedure is to restrict food intake or nutrient intake, which will help the patient lose weight and thus help prevent complications. The gastric band is one of the best known and most popular methods of bariatric surgery because it can be completely removed after a certain period of time.

The diameter of the stomach is thereby narrowed in the entrance area, in the course of a laparoscopic operation the physician applies a silicone band to the stomach fundus and establishes access in front of the breastbone or in the abdominal wall. When gastric bypass, however, a miniaturized stomach is used, which is contacted by the doctor with a loop of the small intestine. Another section of the small intestine will begin to absorb the digestive juices. In a biliopancreatic diversion with Duodenalswitch again prevents a gatekeeper mechanism in the stomach, the fall of sugar and thus the rise in blood sugar.

During this procedure, the duodenal stump is sealed, with the doctor connecting the duodenum to the ileum. The fourth and last accepted method of bariatric surgery is the tube stomach. This intervention is ultimately one of the gastroplastics and has become known as the first step of the so-called two-step method. The doctor resects the stomach along the curvature, leaving behind a tube-like stomach remnant, which has a much smaller volume than the actual stomach. The severed part of a stomach takes out the doctor completely.

The sutures are usually performed laparoscopically. After this gastric gastric change to the gastric tube, the first weight reduction occurs, with the patient being supported by biliopancreatic diversion to Scopinaro at approximate final target weight two years after the procedure. The actual way of the food passage is not changed in this method, whereby also endoscopic procedures in the tube stomach are in the range of the possible.

Since gastric bands are removed after a certain period of time in order to minimize the risk of infection and the risk of slippage, obesity surgeons often combine gastric banding with the stomach in the long term. This means that during surgery to remove a gastric band, often a tubular stomach is applied at the same time. Which particular obesity surgical procedure is used depends on the personal goals and wishes of the patient as well as the form of the overweight.

Risks, side effects & dangers

An adiposity surgical procedure is always preceded by expert advice from an accredited institution. There are now certified reference, competence and excellence centers in Germany for this purpose.

The prerequisites for adiositological surgery include a body mass index of over 40 or a BMI over 35 combined with comorbidities such as diabetes mellitus or arterial hypertension. The morbid form of obesity must also exist for at least three years and the patient should have a biological age of between 18 and 65 years. Conservative methods such as a multimodal therapy program with nutritional advice and exercise training must be completely exhausted in advance.

In addition, the patient must not bring any profound psychosis or addiction problems. The actual risks of the procedure are strongly related to the chosen method and constitution. Since obesity generally has a negative impact on the risk of anesthesia and surgery, interventions are nowadays performed, as far as possible, laparoscopically or in the form of the NOTES or SILS technique. This is the current bariatric surgery associated with significantly fewer complications than a few years ago.

The methods of this surgical direction change in addition to the weight and the general health of the patient to the positive, as morbid overweight is always associated with negative effects on the general state of health. However, any obesity surgery requires retrospectively a consistent change of diet. In the standard catalog of health insurance, adipositasurgery interventions are not included. Nevertheless, the funds take over the costs incurred in individual cases, if the patient requests the reimbursement with good justification.

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