What is bariatric surgery?
From obesity surgery (or bariatric surgery) refers to surgical measures to combat morbid obesity. This is a specialized field of visceral surgery and deals with the surgical alteration of the gastrointestinal tract. The aim is to support people with morbid obesity, where conventional measures for weight reduction have not been successful in losing weight. It provides medical is the most invasive means to combat morbid obesity and its sequelae. After a bariatric surgical operation, the person concerned must switch to a special, balanced diet. Through the weight loss can be a noticeable improvement of the general health, because many complications are also favorably influenced.
Process
There are numerous surgical procedures, four of which are recognized as standard practice in Germany and customization are: gastric band, sleeve gastrectomy, gastric bypass (Roux-Y gastric bypass) and biliopancreatic diversion with duodenal switch (BPD-DS). These recommendations are taken from the Medical guideline for the Surgery of Obesity (called S3 guideline that of the German Society for General and Visceral Surgery (DGAV) is published and regularly updated in the light of medical knowledge.
Gastric banding, sleeve gastrectomy and gastric bypass exert their effect quite significantly by the food supply is limited (restriction). One limitation of the intake of food ingredients by the body (malabsorption or Malresorption) is achieved primarily at the biliopancreatic diversion with or without duodenal switch (DS), to a lesser extent, with gastric bypass surgery. The malabsorptive techniques reduce (in addition to the food intake restriction) digestion passage so that the food is utilized worse. They are technically complex and complication-prone than the purely restrictive methods. For very severely obese patients (BMI> 60) is recommended rather a restrictive procedure such as the gastric tube.
Other surgical procedures and techniques are valid at the moment (December 2011) as an outsider or as experimental procedures and are performed only in exceptional cases.
A gastric balloon does not belong in the strict sense for bariatric surgery, but is acceptable only as a preparatory method for surgical intervention in specific cases.
The decision to an obesity surgery and the choice of surgical procedure depends on many factors, and the personal desires of the patient. The consultation should take place in an experienced center individually, and optionally repeated. Since early 2010, centers for bariatric and metabolic surgery of the German Society for General and Visceral Surgery (DGAV) as a reference, competence and excellence centers (Frankfurt, Recklinghausen) be certified in Germany. Reference centers have to prove a particular expertise in the field of bariatric surgery, in addition to make centers of excellence 350 operations / year and, among other things conduct scientific studies. Today all primary operations are performed laparoscopically (so-called. Keyhole surgeries, is operated under camera on instruments that are inserted through small incisions in the abdominal cavity), which is gentler to the patient and less complication subject is (less risk of wound healing problems with smaller scars). Meanwhile first surgery (sleeve gastrectomy, gastric banding) were also carried out in the so-called Notes or SILS technique.
Bariatric Surgery - Review
The bariatric surgery is according to recent studies, a successful therapy of morbid obesity, which is, however, not been without criticism. Ultimately, the patient and the doctor must weigh the risks and consequences of bariatric surgery or disposition in high-risk obesity disease.
Dimension surgery
Most measures of obesity surgery are irreversible in most cases. Be operated without direct medical need healthy organs: the healthy gastrointestinal tract is not the cause of obesity. Surgery is performed in the healthy abdomen so that there are all risks of abdominal surgery (e.g intraoperative injury to adjacent organs, eg postoperative suture insufficiency or pneumonia, long-term complications such as adhesions). According to most surgical procedures for a lifetime electrolytes, vitamins, iron and trace elements in addition (supplementierend) must be supplied. It should also be any change in the absorption of drugs.
Dimension psychology
In all conducted psychological investigation before surgery on severe mental illness, which prohibit guideline compliant implementation of an operation, the man remains still left who has developed an obesity. This development of obesity has mostly taken place over years to decades and often is the inadequate food intake compensation for perceived or actual psycho-mental impairments or injuries. This compensation of the food is taken from the operated patients.
A lifetime must be taken on a special diet that requires surgery is no longer selectable.
Also long lasting, qualified psychological care is not assured, since the health insurance reject such a long-term therapy. As part of their aftercare programs Wolfart in Munich Graefelfing offers a behavioral oriented group coaching.
Dimension hormonal control mechanisms
Ultimately, not yet understood on the one hand, the hormonal control circuits that lead to the development of obesity, and secondly, the long-term consequences of surgery with partial removal of neuronal bodies and eliminate hormonal regulatory mechanisms (e.g hormones of the pancreatic islet cells, peptide hormones of the gastro-intestinal tract).
Dimension diabetology
Many operated patients are diabetics whose blood glucose levels improve significantly after surgery to a seemingly normal blood sugar metabolism. At least temporarily, the surgeons create so much better patient outcomes of diabetes mellitus as diabetologists. A cure of diabetes mellitus but has not been shown in studies. After years there is often a recurrence of the diabetic condition. Long-term studies are lacking so far. There also no studies have been published that have included control groups.
Dimensional brain metabolic
According to the Selfish Brain theory by Achim Peters of intervention destabilized by lowering the blood sugar levels brain metabolism. The brain would be less energy supplied than before immediately after the procedure. Either it'll then use to lower energy, resulting in a general exhaustion follow, or else it permanently on laste the stress system, thereby resulting a sudden onset of sustained massive ongoing stress.