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This study investigates gender-specific differences in obesity and the treatment by metabolic bariatric surgery (MBS). The database includes 2393 patients (1725 women, 668 men) from for a high-volume center for bariatric surgery. Demographic, perioperative and follow-up data were retrospectively analyzed. Men had a significantly higher body mass index (BMI) and more frequent obesity-associated diseases. Despite the higher prevalence of obesity in men, women accounted for 80% of the surgical patients. On average men had longer operation times but with the same complication rates. Postoperatively, both sexes experienced a significant reduction in excess body weight, which was slightly more pronounced in women. The study particularly emphasizes the need to better motivate men to undergo obesity treatment in order to reduce the health consequences of morbid obesity in this population group. [ABSTRACT FROM AUTHOR]

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Endoscopy has become established as an important component in all preoperative, intraoperative and postoperative areas of bariatric surgery. As guidelines are not yet available, relevant studies and international position papers have been collected in this article. Preoperatively, endoscopy should be performed before sleeve gastrectomy (SG, detection of reflux status) and before bypass procedures (status survey of the postoperatively no longer accessible distal stomach). Routine endoscopic monitoring should be performed 2–3 years after SG and a OAGB (one anastomosis gastric bypass) for recording of the gastroesophageal reflex disease (GERD) status. In the first line complication management of hemorrhage and leakages, endoscopic procedures have prevailed over surgical ones due to more causal therapeutic approaches (except cases of general peritonitis where lavage and drainages are needed). In the treatment of late complications such as dumping, anastomosis dilatation and stenosis, bariatric endoscopy provides versatile, organ-preserving solutions and continues to demonstrate a high degree of innovation. In these postoperative fields of application, especially in the treatment of late complications, specific knowledge of bariatric anatomy and physiology as well as surgical treatment options are required in addition to endoscopic expertise. The special field of bariatric endoscopy has developed and will have an own importance closely linked to the bariatric surgery. [ABSTRACT FROM AUTHOR]

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Background: Due to unsuccessful conservative treatment concepts and the steady increase in the prevalence of obesity, obesity surgery has gained importance worldwide. In Germany alone, around 20,000 surgical operations for obesity are performed each year. In addition to patient history and physical examination a close interdisciplinary cooperation taking into account the currently applicable standards and guidelines of the professional societies are prerequisites for best patient care and to evaluate and mitigate patient risks. Aim: The aim of this work was to compile and consent experiences of experts in the implementation of applicable standards and guidelines for anesthesia in obesity surgery for daily clinical practice. Method: Anesthesiologists from five bariatric centers, comprising about 10% of the obesity surgery caseload of Germany per year, have collated their clinical experiences to agree on a consensus for procedures. The procedures for preoperative patient evaluation, drug premedication and PONV prophylaxis, induction of anesthesia and drug dosage recommendations for anesthetics were consented based on the authors' practice. Results and conclusion: The procedures described herein were developed as part of a joint work process. The authors describe a practically applicable approach to the anesthesiological care of obesity surgery patients and recommend using a pragmatic formula for dosing the medication calculated on the basis of total body weight (TBW). [ABSTRACT FROM AUTHOR]

Background: Only a small proportion of patients with morbid obesity in Germany have access to the currently most effective treatment, bariatric surgery. A major reason for this is the restrictive attitude of health insurance companies regarding the reimbursement of costs. Objective: To record the postoperative rate of cost coverage by health insurance companies without the currently common preoperative application for morbidly obese patients who received a guideline-indicated bariatric surgery. Methods: The process of postoperative reimbursement was evaluated through a prospective database over a 2-year period. Cases of primary reimbursement were correlated with respect to age, BMI, comorbidities and membership of a specific health insurance company. Rejected coverage cases were followed up for further advocacy and social court process. Results: A total of 188 patients underwent bariatric surgery as indicated in the guidelines without prior application. Primary cost coverage was achieved in 76.6% (n = 144). There was no correlation with BMI, comorbidities or health insurance affiliation. Patients over 40 years of age were significantly more likely to be covered for costs. For patients without postoperative cost coverage, an out of court settlement was reached in 7 cases, 8 cases were heard by the social courts and 29 cases were still being processed by lawyers. Conclusion: Despite the relatively high rate of primary cost coverage, this analysis also shows the restrictive attitude of the health insurance companies regarding bariatric surgery with corresponding economic pressure on the service providers. The consistent implementation of application-free surgery seems necessary to increase the political pressure on health insurers and social courts. [ABSTRACT FROM AUTHOR]

Bariatric surgery is the most efficient treatment for obesity and associated diseases. Basic knowledge about the indications, common procedures, follow-up and possible complications has become essential for primary care practice. This article explains the current standards of care in Switzerland with a focus on relevant information for the practice: nutritional aspects after bariatric surgery, necessary clinical and laboratory examinations, early detection of complications. Only intense interdisciplinary and interprofessional collaboration leads to a treatment success in morbid obesity. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is a chronic disease characterized by increased body fat mass and adipose tissue dysfunction, the pathogenesis of which is based on a neurobiological regulatory disorder of energy homeostasis. The primary aim of medical obesity therapy is to reduce the pathologically increased body fat mass and thus prevent secondary diseases and improve comorbidities. In this sense, bariatric-metabolic surgery is currently the most effective obesity therapy. In addition, new agents, which are essentially based on GLP-1 receptor agonism, are making pharmacological therapy increasingly effective. It is important to note that both bariatric-metabolic surgery as well as the pharmacological obesity therapy have direct effects on the central nervous regulation of energy homeostasis and, in particular, hunger and appetite, and therefore represent pathogenetically causal therapies. In this overview, we aim to shed light on the aforementioned medical interventions for obesity therapy and place them in the context of a pathogenetic disease concept., Competing Interests: Prof. Dr. med. Bernd Schultes gibt an, Vortragstätigkeiten für die Firmen Novo Nordisk, Elli Lilly, Johnson Johnson, Böhringer-Ingelheim durchzuführen sowie an advisory boards dieser Firmen teilzunehmen. Diese Firmen produzieren und/oder erforschen u.a. Arzneimittel und Medizinprodukte zur Behandlung von Adipositas. Zudem war er als Investigator an klinischen Studien der Firma Novo Nordisk beteiligt. Dr. rer. hum. biol. Barbara Ernst gibt an, als Studienkoordinatorin an klinischen Studien der Firma Novo Nordisk beteiligt gewesen zu sein. Prof. Dr. med. Marco Bueter gibt an, Vortragstätigkeiten für die Firmen Johnson Johnson und Medtronic durchzuführen., (© 2024 Aerzteverlag medinfo AG.)

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Bariatric and metabolic surgery is increasingly being utilized in Germany and also worldwide. Due to the increased perioperative risk compared to non-obese patients, a detailed and accurate preoperative assessment of the patient is pivotal to improve postoperative and long-term outcomes. The indications for bariatric surgery have shifted in recent years from a certain body mass index (BMI) to comorbidity-based indications. In 2018 the German S3 guidelines for metabolic surgery defined the indications for bariatric surgery as well as the preoperative assessment. The indications for bariatric metabolic operations should be assessed by an interdisciplinary team consisting of surgeons, internists, diabetologists, psychologists and dietitians. It is paramount that surgeon and patient define realistic goals of these operations. Also, the different types of bariatric operation and their long-term consequences should be discussed. Additionally, a thorough endocrinological assessment by an internist or diabetologist with respect to relevant comorbidities of obesity as well as the adjustment of existing therapies are important. An assessment by a mental health professional is also mandatory; however, psychological comorbidities are not a contraindication as long as the patient is being treated and the disease is controlled. A preoperative short-term high-protein and low-carbohydrate fluid nutrition helps to reduce the risk of postoperative complications, especially for patients with a high BMI. A preoperative weight loss in the sense of a mandatory loss of a defined proportion of the body weight is not useful. [ABSTRACT FROM AUTHOR]

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Copyright of Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Gynäkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Gastrointestinal bleeding (GIB) can occur as a complicating issue in the postoperative course after visceral surgery. It can be of varying clinical extent ranging from mild anemia to fatal hemorrhagic shock. Symptomatic manifestations of a GIB are hematemesis, melena and hematochezia. The GIB are fundamentally differentiated into upper and lower GIB. While upper GIB is defined as the occurrence of endoluminal hemorrhage above the ligament of Treitz, correspondingly the definition of lower GIB is intraluminal bleeding distal to the duodenojejunal flexure. Knowledge of their procedure-related incidence during the postoperative course enables a better assessment of the necessary intervention. [ABSTRACT FROM AUTHOR]

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Zusammenfassung: Hintergrund: Die chirurgische Therapie der Adipositas in Deutschland ist ein sich rasch entwickelndes Gebiet, welches streng an die Nationalen Leitlinien gebunden ist. Ziel der Arbeit: Darstellung der Belastung der Adipositaszentren durch den exponentiellen Anstieg postbariatrischer Patienten Methodik: In einer retrospektiven Studie haben wir deskriptiv die Entwicklung der ambulanten Patientenzahlen an unserem universitären Adipositaszentrum (gegründet 2007) untersucht. Die Patientenbesuche wurden jährlich ausgewertet und in zwei Gruppen eingeteilt: Erstvorstellung und Wiedervorstellung. Die Anzahl der durchgeführten bariatrischen Operationen sowie deren Akzeptanz/Kostenübernahme durch die Krankenkassen wurden ebenfalls evaluiert. Ergebnisse: Im Jahr 2007 wurden insgesamt 318 Patienten gesehen: 156 waren Erstvorstellungen, 162 Wiedervorstellungen. Die Ablehnungsrate der Kostenübernahme durch die Krankenkassen betrug 16,8 %. 2016 gab es 1691 Patientenvorstellungen (2016 vs. 2007 + 532 %), hiervon 487 Erstvorstellungen (+312 %) und 1204 Wiedervorstellungen (+743 %). Die Ablehnungsrate seitens der Krankenkassen fiel auf 1,8 %, während sich die Anzahl der Operationen nahezu verzehnfachte. Schlussfolgerung: Mit der steigenden Akzeptanz der bariatrischen Therapie muss sich eine vergleichsweise kleine Zahl an spezialisierten Zentren mit der exponentiell steigenden Nachsorgefrequenz auseinandersetzen. In Anbetracht des Ausmaßes der Adipositasepidemie stellt insbesondere eine adäquate Nachsorge ein sozioökonomisches Problem dar, welches nur im interdisziplinären Setting unter struktureller Integration in das komplexe Gesundheitssystem gelöst werden kann. [ABSTRACT FROM AUTHOR]

Die chirurgische Therapie metabolischer Erkrankungen hat sich in den letzten Jahren als effektive Alternative zur konservativen Therapie etabliert. Die neuen S3-Leitlinien adressieren diese Veränderungen und geben klare Indikationen für die Adipositaschirurgie. Einer der Kernpunkte der neuen Leitlinien stellt die Unterscheidung der Adipositaschirurgie von der metabolischen Chirurgie dar. Bei der Adipositaschirurgie ist der Gewichtsverlust das primäre Therapieziel, während es bei den metabolischen Indikationen die Verbesserung der Komorbidität unabhängig vom BMI ist. Bezüglich der Verfahrensauswahl können die SG und der traditionelle RYGB als sichere und mit harter Evidenz belegte Operationen angewandt werden. Der RYGB hat bessere metabolische Effekte bei jedoch auch höheren Komplikations- und Reinterventionsraten. Neuere Verfahren wie der „one anastomosis gastric bypass" oder der „single anastomosis duodeno-ileal" haben möglicherweise leicht stärkere metabolische Effekte, wobei allerdings auch das Risiko für Mangelernährung und Vitaminmängel höher ist. [ABSTRACT FROM AUTHOR]

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These clinical practice guidelines represent the consensus opinion of a group of Austrian specialist physicians associated with the treatment of obesity. The recommendations incorporate the current literature and guidelines and aim to balance both procedural feasibility and patient acceptance and adherence. Special emphasis was placed on simplification of the preoperative clarification and maximum patient safety. Therefore, this article makes no claim to be complete in all fields., (© 2023. The Author(s).)

Hintergrund: Die Einführung der roboterassistierten Chirurgie hat das Armamentarium des Chirurgen in der Bauchchirurgie erweitert einschließlich der bariatrischen Chirurgie mit Schlauchmagen und Bypasschirurgie. Im Beitrag wird die Umwandlung einer Magenreduktionsplastik (Gastroplastie) nach Mason in einen Magenbypass unter Zuhilfenahme eines DaVinci-Xi-Roboters beschrieben.Fall: Bei einer 29-jährigen Patientin wurde 1995 eine Magenreduktionsplastik nach Mason am offenen Bauch durchgeführt (BMI vom 53,2 kg/m2). Der Verlauf war durch eine Revision des Situs wegen eines Abszesses mit nachfolgender Sekundärheilung kompliziert. 1996 wurde wegen anhaltendem gastroösophagealem Reflux bei Outletstenose eine offene Revision der Magenplastik mit Erweiterung des Outlets und eine offene Cholezystektomie wegen Cholezystolithiasis durchgeführt. Eine Bauchdeckenstraffung wurde 2001 durchgeführt, nachdem die Patientin 68 kg abgenommen hatte. Wegen ungenügender Gewichtreduktion selbst mit Zunahme seit 2001, Adhäsionsbeschwerden und therapierefraktärem gastroösophagealem Reflux wurde die Patientin in unserer Klinik vorstellig. Die klinische Untersuchung ergab zunächst reizlose Narbenverhältnisse ohne Hinweis auf eine Narbenhernie. Der BMI betrug 48,2 kg/m2 bei einem Gewicht von 124 kg. Die Operation wurde mit dem DaVinci Xi nach Zugang über eine stumpfe Dissektion mit Einbringen zweier Trokare und Adhäsiolyse ausgeführt. Der Magenpouch wurde mit Echelon 60 mm über einen Zusatztrokar modelliert. Die Gastroenterostomie wurde mit einer 150 cm langen alimentären Schlinge und einer 60 cm langen biliodigestiven Schlinge als Roux-Y-Bypass angelegt. Die Operationszeit betrug 224 min.Resultat: Der postoperative Verlauf war komplikationslos. Die enterale Ernährung konnte am 1. postoperativen Tag wieder aufgenommen werden und am 4. postoperativen Tag konnte die Patientin das Krankenhaus verlassen.Schlussfolgerung: Der Einsatz der Roboterchirurgie kann selbst nach komplizierter bariatrischer Operation sicher durchgeführt werden. [ABSTRACT FROM AUTHOR]

Einleitung: Die Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) trägt mit ihrer Initiative, chirurgischen Abteilungen Zertifikate zu verleihen, dazu bei, die Qualität der Kliniken zu verbessern und transparent zu machen. Hierzu stellt die Zertifizierungsordnung hohe personelle und strukturelle Anforderungen.Ziele: Die Umfrage der Chirurgischen Arbeitsgemeinschaft Adipositastherapie und metabolische Chirurgie (CAADIP) 2017 sollte klären, welchen Herausforderungen und Hindernissen sich CAADIP-Mitglieder im Rahmen der Zertifizierung zum Zentrum für Adipositas- und metabolische Chirurgie stellen müssen.Methodik: Zwischen Februar und März 2017 wurden alle 417 Mitglieder der CAADIP webbasiert zur Teilnahme an einer Umfrage eingeladen, die den Fokus auf die aktuelle Versorgungslage legte.Ergebnis: Insgesamt 214 (51 %) CAADIP-Mitglieder beteiligten sich. 47 % sind nicht an einem zertifizierten Zentren und 53 % an einem zertifizierten Zentrum tätig. Diese verteilen sich zu 68 % auf Kompetenz-, 21 % auf Referenz- und 11 % auf Exzellenzzentren. 86 % der an nichtzertifizierten Zentren Tätigen gaben an, eine DGAV-Zertifizierung anzustreben. Die Neugründung eines bariatrischen Schwerpunkts ist für 54 % ein Grund, nicht zertifiziert zu sein. Fehlende Eingriffszahlen waren zu 71 %, fehlende personelle Strukturen zu 28 % und fehlende Krankenhausinfrastruktur zu 13 % ein Grund nicht zertifiziert zu sein. 24 % der Befragten gaben an, dass der Krankhausträger kein Interesse an einer Zertifizierung habe und 12 % der Antwortenden sahen selbst keine Notwendigkeit.Schlussfolgerung: Die DGAV-Zertifizierung wird vom größten Teil der CAADIP-Mitglieder angestrebt. Die Haupthindernisse auf dem Weg zur Zertifizierung sind zeitliche Vorgaben (Referenzjahre) und die geforderten Mindestfallzahlen. [ABSTRACT FROM AUTHOR]

Die Prävalenz von Adipositas und Übergewicht nimmt stetig zu. So wird Adipositas derzeit als eines der wichtigsten Probleme des deutschen Gesundheitssystems angesehen. Chirurgische Eingriffe sind für Patienten mit morbider Adipositas oftmals die einzige Möglichkeit, eine nachhaltige Gewichtsreduktion und Verbesserung der adipositasassoziierten Begleiterkrankungen zu erreichen. Im Hinblick auf die im Verhältnis zur Prävalenz geringe Anzahl von in Deutschland durchgeführten Adipositasoperationen werden derzeit mehrere Gründe diskutiert. Allgemeinmediziner spielen eine sehr wichtige Rolle, wenn es um Entscheidungen für oder gegen eine Behandlung geht. Bisherige Forschungsergebnisse weisen darauf hin, dass Wissen und Stigma eine Rolle spielen, wenn Behandlungspfade für Patienten mit Adipositas definiert werden. Interventionen sind erforderlich, um Behandlungsentscheidungen von Ärzten oder Patienten unabhängig von sozialem Druck aufgrund von Stigmatisierung oder Wissenslücken zu gestalten. [ABSTRACT FROM AUTHOR]

An expert committee was appointed by the German Society for General and Visceral Surgery to develop a panel of appropriate quality indicators to collate the quality of results, indications and structure in metabolic and bariatric surgery. This entailed assimilating the available evidence (systematic literature search), results from the national registry of the society (StuDoQ|MBE) and specific socioeconomic aspects (e. g. severely limited access to metabolic and bariatric surgery in Germany). These quality parameters were to be incorporated into the national guidelines and the rules of procedure for certification in the future. The committee concluded that mortality, MTL30 and severe complications needing intervention (Clavien-Dindo ≥ 3b) are suitable indicators to measure surgical outcome quality due to their relevance, scientific soundness and practicability. As a systematic follow-up is mandatory after bariatric surgery, a minimum follow-up quota is now required using reported quality of life data as an indicator of process quality. As intestinal bypass procedures have been shown to be superior in the treatment of type 2 diabetes, these procedures should be offered to eligible patients and also be performed. The proposed threshold values based on the results of the available literature and StuDoQ registry are to be considered as preliminary and need to be validated and adjusted if necessary in the future. The StuDoQ|MBE is considered a valuable tool to gather this information and also represents the appropriate infrastructure for the collation of relevant risk adjustors. [ABSTRACT FROM AUTHOR]

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Copyright of Der Diabetologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Der Diabetologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Background: Morbid obesity is a medical and economic challenge. Patients who have the indications for bariatric surgery face a long way from the first visit until surgery and a high utilization of resources is required. Objectives: The present study aimed to evaluate labor costs and labor time required to supervise obese patients from their first visit until preparation of a bariatric report to ask for cost acceptance of bariatric surgery from their health insurance. In addition, the reasons for not receiving bariatric surgery after receiving cost acceptance from the health insurance were evaluated. Material and methods: Patients who had indications for bariatric surgery according to the S3 guidelines between 2012 and 2013, were evaluated regarding labor costs and labor time of the process from the first visit until receiving cost acceptance from their health insurance. Furthermore, body mass index (BMI), age, sex, Edmonton Obesity Staging System (EOSS) stage and comorbidities were evaluated. Patients who had not received surgery up to December 2015 were contacted via telephone to ask for the reasons. Results: In the present study 176 patients were evaluated (110 females, 62.5%). Until preparation of a bariatric report the patients required an average of 2.7 combined visits in the department of surgery with the department of nutrition, 1.7 visits in the department of psychosomatic medicine, 1.5 separate visits in the department of nutrition and 1.4 visits in the department of internal medicine. Average labor costs from the first visit until the bariatric survey were 404.90 ± 117.00 euros and 130 out of 176 bariatric reports were accepted by the health insurance (73.8%). For another 40 patients a second bariatric survey was made and 20 of these (50%) were accepted, which results in a total acceptance rate of 85.2% (150 out of 176). After a mean follow-up of 2.8 ± 1.1 years only 93 out of 176 patients had received bariatric surgery (53.8%). Of these 16 had received acceptance of surgery by their health insurance only after a second bariatric survey. Conclusion: A large amount of labor and financial resources are required for treatment of obese patients from first presentation up to bariatric surgery. The cost-benefit calculation of an obesity center needs to include that approximately one half of the patients do not receive surgery within more than 2.5 years. [ABSTRACT FROM AUTHOR]