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Background Magnetic sphincter augmentation (MSA) is a surgical intervention for gastroesophageal reflux disease (GERD) which has been evaluated in numerous studies and has shown beneficial effects. Long-term effectiveness data for MSA as well as laparoscopic fundoplication (LF) in patients with GERD are needed. Objective The objective of this study was to evaluate the 3-year outcomes for MSA and LF in patients with GERD. Methods This prospective, multi-center, observational registry study evaluated MSA and LF in clinical practice over 3 years (ClinicalTrials.gov identifier: NCT01624506). Data collection included baseline characteristics, reflux symptoms, medication use, satisfaction and complications. Post-surgical evaluations were collected at yearly intervals. Results Between December 2009 and December 2014, 631 patients (465 MSA and 166 LF) were enrolled in the registry. Both MSA and LF resulted in improvements in total GERD-HRQL score (mean reduction in GERD-HRQL from baseline to 3 years post-surgery: MSA 22.0 to 4.6 and LF 23.6 to 4.9) and in satisfaction (GERD-HRQL satisfaction increase from baseline to 3 years: MSA 4.6% to 78.2% and LF 3.7% to 76.5%). Most patients were able to belch as needed with both therapies (MSA 97.6% and LF 91.7% at 3 years). MSA allowed a higher percentage of patients the ability to vomit as needed (MSA 91.2% and LF 68.0% at 3 years). PPI usage declined from baseline to 3 years for both groups after surgery (MSA 97.8% to 24.2% and LF 95.8% to 19.5%). The mean procedure time was shorter for MSA than for LF. Intraoperative and procedure-related complication rates (≤ 2%) were low for both therapies. Conclusions This 3-year prospective observational registry study contributes to the mounting evidence for the effectiveness of MSA and LF. Despite the more severe nature of GERD in the LF group, the clinical outcomes for MSA and LF were favorable from an effectiveness and safety standpoint.

Einleitung: Die Manifestation von enterokutanen Fisteln ist mannigfaltig. Sie kann von einer kontrollierten Sekretion uber die Bauchdecke bis zu einem septischen Krankheitsbild reichen. Man unterteilt die Erkrankung in Low-, Moderate- und High-Output-Fisteln. Haufig ist die operative Therapie einzige Option. Gelegentlich gibt es unter konservativer Therapie spontane Abheilungen. Ziel dieser Arbeit war es, eine eventuell bestehende Subgruppe, die von einer konservativen Behandlung profitiert, herauszuarbeiten. Material und Methodik: 99 Patienten mit einer enterokutanen Fistel wurden im Zeitraum vom 01.01.1995 bis 31.12.2005 behandelt. 70 Patienten wurden operiert, 29 Patienten konservativ behandelt. Alle Daten wurden mittels eines Aufnahmebogens prospektiv erhoben und retrospektiv ausgewertet. Die konservative Therapie bestand aus Nahrungskarenz mit parenteraler Ernahrung, operativ wurden entweder Fistelubernahungen oder Resektionen durchgefuhrt. Additive Therapien wie Vakuumverbande und TNF-α-Medikation bei Morbus Crohn erfolgten nicht. Ergebnisse: Wir erreichten in unserer Studie eine Gesamtheilungsrate von 69 % bei einer durchschnittlichen Liegedauer von 38 Tagen. Mit der operativen Therapie lassen sich deutlich bessere Ergebnisse erzielen als mit der konservativen Therapie (83 vs. 34 %). Die Letalitat war in der operativen Gruppe mit 7 %, verglichen mit 14 % in der konservativen Gruppe, deutlich, aber nicht signifikant verringert. Bei den konservativ abgeheilten Fisteln handelte es sich ausschlieslich um Low-Output-Sekretionsmengen. Schlussfolgerung: Enterokutane Fisteln sind ein Krankheitsbild mit langen Liegedauern und somit kostenintensiven Behandlungen. Low-Output-Fisteln konnen spontan abheilen. Die besten Erfolge werden durch chirurgische Behandlung erreicht. Es gibt mit der Vakuumtherapie und TNF-α-Medikation bei Morbus Crohn neuerdings vielversprechende Ansatze. Diese werden zukunftig sicherlich zu einem Grosteil mit einer chirurgischen Therapie kombiniert werden mussen.

Background. Evidence-based data on optimal approach for prophylaxis of deep venous thrombosis (VTE) and pulmonary embolism (PE) in bariatric operations is discussed. Using antithrombotic prophylaxis weight adjusted the risk of VTE and its complications have to be balanced with the increased bleeding risk. Methods. Since 2005 the current situation for bariatric surgery has been examined by quality assurance study in Germany. As a prospective multicenter observational study, data on the type, regimen, and time course of VTE prophylaxis were documented. The incidences of clinically diagnosed VTE or PE were derived during the in-hospital course and follow up. Results. Overall, 11,835 bariatric procedures were performed between January 2005 and December 2010. Most performed procedures were 2730 gastric banding (GB); 4901 Roux-en-Y-gastric bypass (RYGBP) procedures, and 3026 sleeve gastrectomies (SG). Study collective includes 72.5% (mean BMI 48.1 kg/m2) female and 27.5% (mean BMI 50.5 kg/m2) male patients. Incidence of VTE was 0.06% and of PE 0.08%. Conclusion. VTE prophylaxis regimen depends on BMI and the type of procedure. Despite the low incidence of VTE and PE there is a lack of evidence. Therefore, prospective randomized studies are necessary to determine the optimal VTE prophylaxis for bariatric surgical patients.

Background: Since January 1st of 2005, the situation of bariatric surgery is being analyzed in Germany. The data is registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. Methods: The data is registered through an online database which includes all information for primary and revision bariatric procedures as well as yearly follow-up. Participation in the quality assurance study is optional. All certificated centers have to participate at the survey. Results: From January 2006 to December 2009, 1478 sleeve gastrectomies (SG) were performed at 45 hospitals. The number of procedures has increased from 126 in 2007 to 933 in 2009. The main complication is leakage of the staple-line. Initial leakage rate was 7% in 2007. Leakage rate dropped down to 2.3% in 2008 and 2.5% in 2009. Mean age of patients was 43.1 years and mean BMI was 52.83 kg/m2. Age and BMI were significantly higher in patients with SG than in all other patients undergoing bariatric surgery. Conclusion: SG is a common and hype bariatric procedure in Germany, but postoperative complication rate is high. Data on the long-term effect of SG on weight loss and amelioration of comorbidities need to be evaluated. More detailed analyzes are necessary to establish the position of SG in the bariatric surgery. Further studies should also include examinations on long-term complications and redo-procedure after SG.

The objective of this study was to investigate the relationship between binge eating and temperament variables, controlling for depression and adult attention deficit/hyperactivity disorder (ADHD), in 90 extremely obese individuals. The participants completed questionnaires assessing eating pathology, reactive temperament, effortful control, depression and ADHD and were grouped based on the presence of regular binge eating. Patients reporting regular binge eating did not differ from patients not reporting regular binge eating with respect to BMI, age, gender, the occurrence of adult ADHD and reactive temperament. However, individuals with binge eating exhibited more pathological scores with regard to eating pathology, depression and effortful control. A logistic regression analysis revealed that only eating concerns and reduced effortful control remained significantly associated with regular binge eating. Binge eating in morbidly obese individuals appears to be associated with a lack of effortful control. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

Background Research suggests that obese children, adolescents and adults frequently suffer from attention-deficit/hyperactivity disorder (ADHD). The aim of the current study was to estimate the prevalence of adult ADHD in a group of patients with grade 3 obesity (body mass index ≥40 kg/m2) prior to bariatric surgery. Method We assessed 116 patients for childhood and adult ADHD, co-occurring psychiatric disorders, severity of depression and daytime sleepiness. Results Fourteen participants (12.1%) screened positive for adult ADHD. Even though this rate is higher compared with prevalence rates in representative population samples, it was not elevated compared with a group of morbidly obese individuals in a German general population sample (14.3%). Adult ADHD was associated with greater severity of depressive symptoms and more psychotherapy contact in the past but not with binge eating disorder or daytime sleepiness. Conclusion As ADHD appears to be a common condition in morbidly obese individuals, the impact of adult ADHD on postsurgical weight loss needs to be examined. Besides, the causal link between obesity and ADHD in adults should be further investigated. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

Objectives: To assess the pharmacokinetics of moxifloxacin in morbidly obese patients. Methods: Twelve morbidly obese patients (2 male/10 female, age 25‐61 years, weight 98 ‐166 kg, body mass index 43.0‐ 58.2 kg/m 2 ) scheduled for gastric bypass surgery were treated with 400 mg of moxifloxacin orally once daily for 3 days and with 400 mg of moxifloxacin intravenously on day 4 (day of surgery). Pharmacokinetic analysis was performed on day 1 and day 4. Specimens of small intestine, greater omentum and subcutaneous adipose tissue were collected intraoperatively 1.8 ‐3.7 h after moxifloxacin infusion. Moxifloxacin concentrations were determined by HPLC. Results: The plasma pharmacokinetics (mean+SD) was comparable to historical data in normal-weight subjects. Oral bioavailability was 79.6%+11.5%. After intravenous administration, plasma clearance was 9.6+2.0 L/h, volume of distribution was 165+30 L and area under the curve was 43.7+11.8 mg.h/L. Linear regression analysis showed the volume of distribution to be better correlated with ideal body weight, lean body weight, fat-free mass or height (R 2 ¼0.60 ‐0.67, P ¼ 0.001‐0.003) than with total body weight (R 2 ¼ 0.46, P ¼ 0.015). Whereas mean tissue concentrations in small intestine (6.99+2.34 mg/kg) were twice the concomitant plasma concentrations, the concentrations in greater omentum (0.801+0.168 mg/kg) or subcutaneous fat (0.638+0.180 mg/kg) were only one-quarter of those. Conclusions: The pharmacokinetics of moxifloxacin is not significantly affected by morbid obesity. No dose adjustment seems to be necessary in this particular population.

Die chronische Erkrankung Diabetes mellitus kann durch operative Masnahmen im Sinne einer metabolischen Chirurgie effektiv beeinflusst werden. Durch relevante Gewichtsreduktion, hormonelle Veranderungen, Ausschluss der duodenalen Nahrungspassage oder Verlangsamung der Magenentleerung kann eine Ruckbildung der diabetischen Stoffwechsellage oder zumindest eine erhebliche Vereinfachung der Standardtherapie erreicht werden. Angesichts der steigenden Zahl von Diabetikern und der begrenzten Ressourcen des Gesundheitssystems sollte metabolische Chirurgie als Behandlungsoption in Therapieleitlinien aufgenommen werden. Eine qualitativ hochwertige und sichere Versorgung der Patienten setzt interdisziplinare Betreuung und eine Zertifizierung von Behandlungszentren voraus.

OBJECTIVE: To evaluate the psychometric properties of a German version of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire. METHOD: IWQOL-Lite scores were obtained from 351 overweight/obese individuals and 127 lean adult volunteers. In addition, a subgroup of 126 obese subjects completed also the German versions of the 36-item short-form health survey (SF-36), the Beck Depression Inventory (BDI), the Eating Disorder Examination-Questionnaire (EDE-Q), and the German validated version of the Three-Factor Eating Questionnaire (TFEQ). RESULTS: The German version of the IWQOL-Lite has psychometric properties comparable to those found for the original version and demonstrates high internal consistency and excellent construct validity. Furthermore, the German IWQOL-Lite clearly discriminates between groups based on BMI on all subscales and the total score. CONCLUSION: The results of the present study suggest that the German IWQOL-Lite is a psychometrically validated instrument with which to measure weight-specific health related quality of life.

Im Hinblick auf die Bedrohlichkeit des akuten Abdomens ist eine rasche und effektive Diagnostik von entscheidender Bedeutung. Dabei lassen sich zwei Tendenzen unterscheiden: 1. genereller Einsatz aufwendiger Untersuchungen (CT, MRT) bei allen Patienten und 2. Stufendiagnostik mit bedarfsorientierter erweiterter Diagnostik. Ziel unserer Untersuchung war es, unsere standardisierte Stufendiagnostik auf ihre Aussagekraft zu untersuchen. Insgesamt wurden 444 Patienten mit der Einweisungsdiagnose „akutes Abdomen“ untersucht. Alle Daten wurden prospektiv erhoben und retrospektiv analysiert. Die Basisdiagnostik bestand bei allen Patienten aus Anamnese, klinischer Untersuchung, Laboruntersuchungen, abdomineller Sonographie und Rontgenubersichtsaufnahme. Sie wurde nur bei Bedarf erganzt durch erweiterte Masnahmen wie z. B. CT, Kolonkontrasteinlauf, endoskopische Untersuchungen und diagnostische Laparotomie. Es konnten drei Krankheitsgruppen mit unterschiedlichem diagnostischem Bedarf identifiziert werden. Bei der 1. Gruppe, dargestellt am Beispiel der Appendizitis, reicht die Basisdiagnostik bei uber 80% der Patienten aus. Erweiterte Masnahmen in Form der CT betrafen 14%. Die negative Appendektomierate betrug 8%. Zu dieser Gruppe gehoren auch der Ileus, die akuten Gallenwegserkrankungen, Perforationen etc. Bei der 2. Gruppe, am Beispiel der Divertikulitis dargestellt, war hingegen in 84% der Falle eine erweiterte radiologische Diagnostik erforderlich. Ahnliches ist auch fur die Pankreatitis zu erwarten. Bei der 3. Gruppe, dargestellt am Beispiel der Koprostase, lagen in 39% Zweiterkrankungen meist entzundlicher Genese vor, deren Symptomatik erst nach Behandlung der Koprostase klinisch apparent wurde. In dieser Gruppe reichte dann die Basisdiagnostik in 84% der Falle aus. Allerdings war in 3% eine diagnostische Laparotomie nicht zu umgehen. Die Stufendiagnostik hat sich generell bewahrt. Sie macht erweiterte diagnostische Masnahmen bei ca 80% der Patienten uberflussig. Lediglich bei Erkrankungen, bei denen neben der Krankheitsdiagnose auch Aussagen zum Krankheitsstadium notwendig sind (Divertikulitis, Pankreatitis u. a.) sollte eine erweiterte Diagnostik von Anfang an angestrebt werden. Die Notwendigkeit zur diagnostischen Laparotomie ist mit 1% stark zuruckgegangen.

The goal of the study was to determine the concordance between mental disorder assessed during clinical evaluation and those independently obtained by a SCID interview in morbidly obese patients prior to bariatric surgery. In 116 patients a SCID interview was conducted. The agreement was moderate for any current diagnosis (kappa 0.43) current affective disorder (kappa 0.41) and current eating disorders (kappa 0.47). For current anxiety disorders agreement was poor wit a kappa of 0.11. For anxiety disorders and eating disorders the use of SCID resulted in more diagnoses than did standard clinical evaluation. Generally, the SCID produced more current axis 1 diagnoses than the clinical evaluation. When conducting a clinical evaluation prior to bariatric surgery a structured clinical interview should be used to assess mental co-mobidity.

Die Menschen in westlichen Landern und Schwellenlandern mit westlicher Ernahrungsform werden immer dicker. Deutschland nimmt hierbei eine ungluckliche Spitzenposition in der EU ein. Mit Adipositas sind viele Krankheiten assoziiert, z.B. Typ-2-Diabetes, Hypertonie, Schlafapnoe und Steatosis hepatis. Die Langzeiteffekte konservativer Therapieprogramme bei Adipositas Grad II mit Begleiterkrankungen bzw. Adipositas Grad III reichen nicht aus. Sind konservative Masnahmen erschopft, sollten adipositaschirurgische Interventionen erwogen werden. Bei mindestens 50% der Patienten kann dadurch auch die diabetische Stoffwechsellage verbessert werden. Magenband, Schlauchmagenbildung, Roux-Y-Magenbypass oder biliopankreatische Diversion mit duodenalem Switch haben ihre Effektivitat bewiesen. Laparoskopisch in Zentren mit Erfahrung angewandt, konnen Patienten eine langfristige Gewichtsreduktion mit solider Nutzen-Risiko-Korrelation erreichen. Zur Ergebnissicherung ist aber eine regelmasige, langfristige interdisziplinare Nachsorge notig.

In Deutschland liegt der Anteil Ubergewichtiger MAnner (BMI >25 kg/m2) bei 66% und der Ubergewichtiger Frauen bei 55%. Die Langzeiteffekte konservativer Gewichtsreduktionsprogramme sind bei Adipositas Grad II mit Begleiterkrankungen bzw. Adipositas Grad III unzureichend. Operative Interventionen haben ihre hohe EffektivitAt bewiesen, dabei gilt die minimal invasive Technik als Standard. Die Auswahl der fUr solche Eingriffe benOtigten Ausstattung im OP bedarf einer Anpassung an die Ubergewichtigen Patienten. Die meisten Instrumente der erweiterten minimal invasiven Chirurgie kOnnen allerdings ohne EinschrAnkung auch fUr bariatrische Prozeduren eingesetzt werden. Spezialinstrumente sind fUr einzelne Operationen erforderlich. Retraktorsysteme fUr die Konversion zu offenen Eingriffen mUssen vorgehalten werden.

Objective To investigate the prevalence of Axis I psychopathology in bariatric surgery candidates and to compare our results with the findings of the few studies published thus far. Method Structured clinical interviews (SCID) were conducted in 146 consecutive bariatric surgery candidates [71.9% women; mean age: 38.7 years (S.D.=10.0); mean BMI: 49.3 kg/m2 (S.D.=7.8)] between September 2004 and January 2007 at the University Hospital of Erlangen. Assessments were administered independently of the preoperative screening and approval process. Results The overall prevalence of current Axis I disorders was 55.5%; 72.6% had a lifetime history of at least one Axis I disorder. Axis I psychopathology was related to gender (with women reporting higher prevalence rates) and was positively associated with a lifetime history of any eating disorder. We compared our results with the findings of the three published studies having used structured clinical interviews to assess psychiatric comorbidity in bariatric surgery candidates. The authors provide an overview of evidence so far and highlight some details in the assessment and comparisons of different samples in different countries. Conclusion About one half of the bariatric surgery candidates in Germany presented with a current Axis I disorder. Prevalence rates reported in the literature so far are based on different premises. Details for example about the evaluation should be taken into account when interpreting the results.

Since January 1st, 2005, the current situation for bariatric surgery has been examined by means of a voluntary quality assurance study in Germany with a multicenter design in which 38 hospitals and surgical departments participated. The data are registered in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany).Data describing peri-interventional characteristics were prospectively documented in an internet online data registry. All primary bariatric procedures performed since January 1st, 2005, were registered. In addition, reoperations in patients who had previously undergone primary surgical intervention were included. As a representative excerpt from the overall prospective multicenter observational study on obesity surgery, data on the type, regimen, and time course of deep venous thrombosis (DVT) prophylaxis were documented. From the number and spectrum of complications, the incidences of clinically manifest DVT or pulmonary embolism (PE) were derived during the in-hospital course and follow-up in conjunction with the type of surgical procedure and body mass index (BMI).Overall, 3,122 bariatric procedures were performed at 38 German hospitals between January 2005 and December 2007. These procedures were subdivided into 2,869 primary operations and 253 revisions (sex ratio, male to female = 25.6:74.4%). The average BMI of all patients was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. In 2005 and 2006, gastric banding (GB) was the most commonly performed operation, followed by Roux-en-Y gastric bypass (RYGBP). In 2007, RYGBP was carried out in 42.1% of all bariatric procedures. Interestingly, the incidence of deep venous thrombosis (DVT) was only 0.06%, whereas PE occurred in 0.06% of patients only after hospital discharge. The DVT prophylaxis protocol used has been changed for the last 2 years: the majority of patients with a BMI above 50 kg/m(2) received low-molecular-weight heparin twice a day.In Germany, a trend from GB to sleeve gastrectomy (SG) and malabsorptive approach has been evaluated. This trend is associated with differences of the DVT prophylaxis regimen in the profile of bariatric surgical patients depending on BMI and the type of bariatric procedure. Despite the low incidence of DVT and pulmonary embolism (PE) detected, there is a lack of evidence on a reasonable regimen for sufficient DVT prophylaxis in bariatric surgery; instead, there are only recommendations from the guidelines and statements of a specific medical society. Therefore, prospective studies are necessary to determine the optimal DVT prophylaxis for bariatric surgical patients as well as obese patients undergoing surgery.

In the majority of patients with oesophageal carcinoma, curative treatment proves to be impossible when diagnosis was established; therefore, most of the patients are candidates for palliative chemotherapy. The aim of this phase II study was to evaluate the efficacy and safety of 5-fluorouracil/folinic acid (AIO regimen) plus irinotecan in patients with locally advanced or metastatic carcinoma of the oesophagus. The methods used a prospective phase II trial, start: November 2002; patients: n=25; chemotherapy: irinotecan (80 mg/m2) as a 1-h infusion and 5-fluorouracil (2000 mg/m2) with sodium folinic acid (500 mg/m2) as a 24-h infusion on days 1, 8, 15, 22, 29 and 36, repeated on day 57. Last date of evaluation: 28 February 2007; n=24; adenocarcinoma: n=13, squamous cell carcinoma (SCC): n=11; UICC III/IV: 3/21; grading G1/G2/G3/G4: 0/8/12/4; median age: 58 years (range 44-75); men/women: 19/5; Eastern Cooperative Oncology Group index 0/1/2: 3/17/4; applications: 460. Higher-grade toxicity: grade 3 diarrhoea: n=2, grade 4 diarrhoea: n=1, grade 4 vomiting: n=1, grade 4 nausea: n=1, grade 3 fatigue: n=1, grade 3 hyponatraemia: n=2, grade 4 elevation of creatinine: n=1, thrombosis of the vena subclavia: n=1, ischaemic lesion of the brain stem: n=1. Three patients died after two chemotherapeutic applications because of high tumour burden. Evaluable for response: n=19. Partial response: n=8 (33%), stable disease: n=9 (38%), progressive disease: n=2 (8%), not evaluable: n=5 (21%). Time-to-progression: 6.6 months (range 1.6-24.6). Total median survival: 13.6 months (median survival of adenocarcinoma: 20.3 months, median survival of SCC: 10.0 months). Secondary resection (R0): n=3. In oesophageal carcinomas, the AIO regimen plus irinotecan is excellently manageable as an outpatient treatment and shows efficacy in adenocarcinomas and SCCs of the oesophagus.

Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined since January 1st, 2005 with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany).In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an Internet online data registry. In particular, perioperative characteristics, such as the spectrum of diagnostic measurements, type of surgical procedures, and short- and long-term outcomes, were investigated.During the study period, 629 surgical procedures were performed at 21 hospitals in 2005, 828 procedures at 32 hospitals in 2006, and 1,666 procedures at 35 hospitals in 2007. In 2005 and 2006, gastric banding was the most frequently performed operation, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean body mass index (BMI) was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients in 2005 and 2006; these data showed greater reduction of BMI after malabsorptive rather than restrictive bariatric procedures. The mortality was 0.1% (30 days) and 0.16% (overall).As indicated by the worldwide trend, there is an ongoing change from restrictive bariatric procedures to malabsorptive procedures and sleeve gastrectomy. Although the BMIs of German patients undergoing bariatric surgery appear to be substantially higher than those of patients from most other countries, there were no differences in intraoperative and short-term complications or in overall outcomes during follow-up when compared with published studies.

Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

The objective was to compare two methods for assessing eating disorder psychopathology in pre-gastric banding surgery patients. 93 morbidly obese patients were assessed with the German versions of the Eating Disorder Examination (EDE) and the Eating Disorder Examination-Questionnaire (EDE-Q). The EDE and the EDE-Q were significantly correlated on the restraint, eating concern, shape concern and weight concern subscales, although the questionnaire scores were significantly higher. Frequencies of objective bulimic episodes were slightly but significantly correlated and the difference between EDE and EDE-Q was not significant. When participants were classified as binge eaters based on a cut-off of two binges per week on average in the last 28 days, the concordance between EDE and EDE-Q was moderate. The EDE-Q seems well-suited in assessing eating disorder psychopathology in obese pre-gastric banding patients. Yet, for the assessment of binge eating episodes the use of the questionnaire alone can not be recommended.

Buried bumper syndrome is a rare complication of percutaneous endoscopic gastrostomy with an overgrowth of the inner flange of the tube. Various therapeutic approaches in case studies in the literature are described.We present the prospective data collection and analysis of 18 cases of buried bumper syndrome treated in our institution between 1 January 1998 and 31 December 2005.The median length of time after the first percutaneous endoscopic gastrostomy (PEG) tube insertion was 35 months (range = 1-168 months). In 37 endoscopic interventions all ingrown PEG's could be removed or replaced. Our experience resulted in a structured clinical treatment algorithm.In all cases inadequate gastrostomy care must be assumed as the reason for bumper overgrowth. Following ESPEN guidelines for PEG care may prevent BBS. BBS can routinely be diagnosed and treated by upper gastrointestinal endoscopy in a minimally invasive manner.

Since January 1, 2005, the situation of bariatric surgery has been examined in Germany. The data are registered in cooperation with the An-Institute of Quality Assurance in the Surgery Department a

The techniques available for antireflux surgery have expanded with the introduction of the magnetic sphincter augmentation device (MSAD) for gastroesophageal reflux disease (GERD).A prospective, multicenter registry evaluated MSAD and laparoscopic fundoplication (LF) in clinical practice (ClinicalTrials.gov identifier: NCT01624506). Data collection included baseline characteristics, reflux symptoms, proton-pump inhibitor (PPI) use, side effects, and complications. Post-surgical evaluations were collected at one year.At report, 249 patients (202 MSAD patients and 47 LF patients) had completed one-year follow-up. The LF group was older and had a greater frequency of large hiatal hernias and Barrett's esophagus than the MSAD group (P0.001). The median GERD-health related quality of life score improved from 20.0 to 3.0 after MSAD and 23.0 to 3.5 after LF. Moderate or severe regurgitation improved from 58.2 to 3.1% after MSAD and 60.0 to 13.0% after LF (P = 0.014). Discontinuation of PPIs was achieved by 81.8% of patients after MSAD and 63.0% after LF (P = 0.009). Excessive gas and abdominal bloating were reported by 10.0% of patients after MSAD and 31.9% following LF (P ≤ 0.001). Following MSAD, 91.3% of patients were able to vomit if needed, compared with 44.4% of those undergoing LF (P0.001). Reoperation rate was 4.0% following MSAD and 6.4% following LF.Antireflux surgery should be individualized to the characteristics of each patient, taking into consideration anatomy and propensity and tolerance of side effects. Both MSAD and LF showed significant improvements in reflux control, with similar safety and reoperation rates. In the treatment continuum of antireflux surgery, MSAD should be considered as a first-line surgical option in appropriately selected patients without Barrett's esophagus or a large hiatal hernia in order to avoid unnecessary dissection and preserve the patient's native gastric anatomy. MSAD is an important treatment option and will expand the surgeon's role in treating GERD.

Purpose: The aim of this study was to evaluate the quality of care and interdisciplinary cooperation in the palliative treatment of colorectal cancer (CRC), including the associated costs. Patients and Methods: 103 patients were enrolled from 13 institutions to reflect the existing clinical treatment reality and costs of palliative CRC treatment. We present the clinical outcome of the patients and compare the results obtained in the 3 centers with double-figure recruitment numbers (centers A, B, and C). Results: First-line treatment with 5-fluorouracil monotherapy was applied in exceptional cases. The regular treatment method comprised either an irinotecan- (30%) or an oxaliplatin-based regimen (32%). Biological agents were added to the treatment of 33 patients (32%). The median overall survival (OS) of the total patient collective was 25 months. The OS differed significantly in 2 out of the 3 centers, ranging between 27 and 11 months. Secondary metastasis resections were performed in 26% of the total patient collective. The center with the most favorable outcome results also had the lowest costs for palliative treatment and care, including the lowest drug costs. Conclusion: A combined chemotherapy treatment was the rule. Concerning biological agents, a significant lack of their application in first-line treatment and the quality of interdisciplinary cooperation have to be addressed. © 2014 S. Karger AG, Basel

To investigate if the vasoactive systems adrenomedullin (ADM) and endothelin-1 (ET-1) are expressed in human adipose tissues in children and in adults and to determine the distribution pattern of nitric oxide synthases (NOS).Subcutaneous, mesenterial and omental adipose tissue specimens taken from 15 children (age 0.5-16 y, median 6 y) and 13 adults (age 43-79 y, median 60 y) were analyzed. The body mass indices (BMI) were within the normal range. All patients were normotensive, and were free of infectious disease, and metabolic or endocrine disorders. The specimens were taken during elective laparotomies after informed consent was obtained.ADM, ET-1, the endothelial (eNOS) and inducible (iNOS) NOS as well as two housekeeping genes were measured using quantitative real-time PCR.ADM gene expression was found at all locations, and was significantly higher in adults than in children (P0.01 for subcutaneous and omental adipose tissue). ET-1 mRNA was distributed in a similar way, showing significantly higher levels in the subcutaneous and mesenterial adipose tissue sections of adults than of children. For eNOS, the adult patients exhibited a higher expression in subcutaneous and mesenterial specimens than the children (P0.01 and P0.05). The iNOS mRNA was increased in subcutaneous, mesenterial and omental adipose tissues in the adult cohort compared to the children's levels (P0.05 to P0.01).Human adipose tissue expresses many vasoactive substances including ADM and ET-1. In adults, the amounts of ET-1 and ADM as well as eNOS and iNOS mRNA are higher, possibly due to a physiological upregulation with increasing age. Although there are differences depending on the locations of the tissues, the expression patterns of the antagonists ADM and ET-1 are quite similar, indicative of a well-balanced pattern of local gene expression in normotensive individuals with normal body weight.

Background In view of its low associated risk of metastatic spread, early gastric cancer has an excellent prognosis. The basis for the choice of treatment is the risk of lymphogenous metastatic spread together with the individual surgical risk. Methods The data collected from 279 patients in whom, between 01/1982 and 12/2001, a gastric resection or gastrectomy was carried out for early gastric cancer at the Surgical Department of the University Hospital, Erlangen, were analysed. A number of macroscopic and histopathological factors were examined by univariate and multivariate analysis for their effect on lymphogenous metastatic spread. Results In 33 patients (11.8%), regional lymph-node metastases were confirmed histologically. The grade of malignancy (high-grade, relative risk 9.9), diameter (>20 mm, relative risk 5.0) and lymphatic invasion (relative risk 3.5) all demonstrated a significant independent influence on the occurrence of regional lymph-node metastases. Seventy-three patients were identified as a low-risk group, with a risk of lymphogenous metastatic spread of only 1%. Conclusions Well differentiated or moderately differentiated carcinomas having a diameter of less than 2 cm can be treated by local intervention, such as local excision or endoscopic removal, without any increase in risk, provided that the tumour is reliably removed without residual tumour (histologically confirmed R0). In the presence of an elevated surgical risk, the choice of treatment must be made on an individual basis.

OBJECTIVE: Adipose tissue displays depot-specific metabolic properties and a predominant gene expression of leptin in subcutaneous tissue. The aim of the study was to evaluate leptin mRNA expression in various adipose tissues and to relate it to plasma leptin concentrations. Furthermore, developmental changes in leptin gene expression from childhood to adulthood were examined. DESIGN AND METHODS: Thoracic subcutaneous and intrathoracic adipose tissue specimens were obtained in 22 adults (51-81 years) and 23 children (0.1-17 years) undergoing cardiac surgery, and abdominal subcutaneous, omental and mesenterial fat specimens were collected from 21 adults (38-79 years) and 22 children (0.2-17 years) before abdominal surgery. Preoperative plasma leptin concentrations were measured by RIA. Leptin mRNA expression was quantified by TaqMan real-time PCR. RESULTS: In adults, there was no difference between leptin gene expression in subcutaneous and intrathoracic fat, whereas in children leptin mRNA expression was significantly higher in subcutaneous adipose tissue. In omental fat, leptin mRNA levels were significantly lower compared with subcutaneous and mesenterial sites in both children and adults. Adults revealed a significantly higher leptin gene expression in subcutaneous, omental and mesenterial adipose tissues than children. Subcutaneous and omental leptin gene expression are independent factors for plasma leptin concentrations in children and adults. CONCLUSION: Leptin is differentially expressed at different adipose tissue sites, a situation which is even more pronounced in children. There is a developmental increase in leptin mRNA expression in adipose tissue during childhood, reaching maximal capacity in adulthood.

As part of the postsurgical stress response, plasma leptin levels increase in-between 12 h postoperatively. Objective: To study the kinetics of leptin gene expression in different adipose tissues before and after severe surgical trauma in children and adults. Methods: In 22 adults and 23 children with cardiac and 19 adult patients with abdominal surgery, we measured plasma leptin concentrations preoperatively, 4 and 10–17 h postoperatively and quantified leptin mRNA expression by TaqMan real-time PCR in adipose tissue taken at the beginning and the end of surgery from subcutaneous, intrathoracic, omental and mesenteric fat. Plasma-soluble leptin receptor levels were measured in 23 children after cardiosurgery. Results: Plasma leptin levels doubled between 4 and 10–17 h postoperatively in adults (p < 0.001) as well as in children (p = 0.0002) with cardiac surgery. After abdominal surgery, 10–17 h postoperatively, plasma leptin concentrations increased significantly (p < 0.05). During the operation, leptin gene expression did not change in neither of the patient groups. Plasma-soluble leptin receptor levels decreased immediately after the onset of surgery and remained unchanged thereafter. Conclusions: Leptin gene expression is not up-regulated during surgery. The measured increase in plasma leptin after surgery does not result from elevated levels of soluble leptin receptor but may follow an up-regulation of leptin gene expression later after the operation due to postsurgical metabolic changes.

Hintergrund. Der onkologische Benefit der in Japan erfolgreich praktizierten erweiterten D3-Lymphdissektion beim in kurativer Absicht operierten Magenkarzinom ist in westlichen Landern bei moglicherweise erhohten Nebenwirkungen nicht erwiesen. Ziel der vorliegenden Arbeit war es deshalb, im Rahmen einer Fall-Kontroll-Studie die gegenwartig praktizierte D3-Dissektion (1995–1999) mit dem historischen D2-Verfahren (1982–1995) retrospektiv zu vergleichen.

Background: The present article describes light-induced autofluorescence spectroscopy using violet-blue excitation light for endoscopic in vivo measurements in the upper GI tract. The spectra of normal mucosa, cancer, and dysplastic lesions of the esophagus and stomach are presented and compared. Methods: Over 120 spectra were obtained in 11 patients of normal mucosa and malignant lesions in the esophagus and stomach during routine endoscopy. A special light source capable of delivering either white or violet-blue light was used for the excitation of tissue auto-fluorescence via the endoscope. Endogenous fluorescence spectra emitted by the tissue were collected with a fiberoptic probe and analyzed with a spectrograph. After spectrographic measurements biopsies were taken for definitive classification of histopathologic status. Results: As compared with normal mucosa, (pre) cancerous lesions were associated with special changes in the emitted fluorescence spectra.The spectrographic records were influenced by the intensity of the illumination and on the position of the probe (distance and angle). Conclusion: Fluorescence spectroscopy with a slightly modified conventional light source might be useful for the endoscopic detection of dysplasia and early-stage carcinoma in the upper GI tract. Prospective trials need to determine the sensitivity and specificity of this new method.

Since November 1995 we have been performing a D3 lymph node dissection in patients undergoing an operation for gastric cancer with a curative intent. The aim of the present study was to evaluate whether this procedure results in an increased postoperative mortality or complication rate in a Western population. Between November 1995 and August 1997 the postoperative courses of 76 patients were retrospectively assessed (45.3 lymph nodes per patient, lymph node ratio: 0.16). The patient outcome was compared with data from a historic control group of patients (n = 383) in whom the newly established D2 dissection was studied in our department. Regarding the demographic, clinical, and tumor-pathologic data, and the choice of resection and reconstructive procedures, the two groups differed only slightly. The postoperative mortality of 1% was lower (vs 6.8%) while the overall complication rate of 34% (vs 32.1%) was identical. In particular, no anastomotic leakage (vs 9.4%) and fewer nonsurgical complications (17.1% vs 27.9%) occurred. The reoperation rate was 1% vs 9.7%. However, in 6% of the patients drainage tubes had to be inserted under computed tomographic guidance. The average hospital stay remained unchanged (21.9 vs 20.7 days). A D3 dissection was shown to be feasible while demonstrating no disadvantages in the patients when compared with the D2 procedure.

The aim of the present study was to examine if obese individuals with obesity-related somatic comorbidity (i.e., hypertension, diabetes, sleep apnea, dyslipidemia, pain disorder) perform worse in neurocognitive tasks compared to obese individuals without any somatic disorder. Neurocognitive functioning was measured by a computerized test battery that consisted of the following tasks: Corsi Block Tapping Test, Auditory Word Learning Task, Trail Making Test-Part B, Stroop Test, Labyrinth Test, and a four-disk version of the Tower of Hanoi. The total sample consisted of 146 patients, the majority (N = 113) suffered from obesity grade 3, 26 individuals had obesity grade 2, and only 7 individuals obesity grade 1. Ninety-eight participants (67.1%) reported at least one somatic disorder (Soma(+)-group). Hypertension was present in 75 individuals (51.4%), type 2 diabetes in 34 participants (23.3%), 38 individuals had sleep apnea (26.0%), 16 suffered from dyslipidemia (11.0%), and 14 individuals reported having a chronic pain disorder (9.6%). Participants without a coexisting somatic disorder were younger [M Soma- = 33.7, SD = 9.8 vs. M Soma+ = 42.7, SD = 11.0, F(1, 144) = 23.01, p 0.001] and more often female [89.6 and 62.2%, χ(2)(1) = 11.751, p = 0.001] but did not differ with respect to education, regular binge eating, or depressive symptoms from those in the Soma(+)-group. The Soma(-)-group performed better on cognitive tasks related to memory and mental flexibility. However, the group differences disappeared completely after controlling for age. The findings indicate that in some obese patients increasing age may not only be accompanied by an increase of obesity severity and by more obesity-related somatic disorders but also by poorer cognitive functioning.

BACKGROUND: Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany) since January 1, 2005. METHODS: In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an internet online data registry. Perioperative characteristics such as the spectrum of diagnostic measurements, type of surgical procedures, and short-and long-term out comes were investigated. RESULTS: During the study period 3,123 surgical procedures were performed. In 2005 and 2006, gastric banding (GB) was the operation performed most frequently, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean BMI ranged from 48.5 kg/m(2) in 2005 to 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients operated in 2005 and 2006. The mortality was 0.1% (30 days) and 0.16% (overall). CONCLUSION: As indicated by the worldwide trend, there is an ongoing change from GB to sleeve gastrectomy (SG) and malabsorptive procedures. The BMI of German bariatric surgical patients is substantially higher than that of patients from most other countries. There were no differences in overall outcomes during follow-up as compared to published studies.

Integrated operation systems were developed for centralization and easy control of all components within the operating room (OR). These systems represent central units that use communication technology to connect and control various components of the OR. Voice control that is independent of the speaker has been a pioneering innovation in the central control of different OR components. The aim of the present study was to evaluate the utility of two voice-activated control systems, the Siemens Integrated OR System (SIOS, Siemens Medical Solutions, Siemens AG) and the OR1 (Karl Storz GmbHCo. KG), for delivery of commands to specific OR equipment.To compare the two systems, actions such as adjusting the operating table, increasing gas pressure, switching on the video recorder, and controlling the endolight source were defined according to a study protocol. These actions were to be executed by test persons through speech and manual control after a suitable training period. The parameters evaluated were training time, time to execute each action, number of repeated commands, and number of functional errors.Seventy-four test persons from five nations were selected to participate. The numbers of repeated commands and functional errors differed significantly between systems in all user groups in favor of the SIOS (mean repeated commands for surgeons: SIOS, 2.4; OR1, 14.7, p0.0001).The SIOS voice control was more effective and more reliable than that of the OR1. Importantly, unlike the OR1, the SIOS produced no functional errors. The appropriate conditions for greater acceptance of these systems must be considered, together with additional technical improvements and possible combinations of advantages of the available systems.

Hypertension is linked to disturbed total-body sodium (Na + ) regulation; however, measuring Na + disposition in the body is difficult. We implemented 23 Na magnetic resonance spectroscopy ( 23 Na-MR) and imaging technique ( 23 Na-MRI) at 9.4T for animals and 3T for humans to quantify Na + content in skeletal muscle and skin. We compared 23 Na-MRI data with actual tissue Na + content measured by chemical analysis in animal and human tissue. We then quantified tissue Na + content in normal humans and in patients with primary aldosteronism. We found a 29% increase in muscle Na + content in patients with aldosteronism compared with normal women and men. This tissue Na + was mobilized after successful treatment without accompanying weight loss. We suggest that, after further refinements, this tool could facilitate understanding the relationships between Na + accumulation and hypertension. Furthermore, with additional technical advances, a future clinical use may be possible.

Research suggests that obese children, adolescents and adults frequently suffer from attention-deficit/hyperactivity disorder (ADHD). The aim of the current study was to estimate the prevalence of adult ADHD in a group of patients with grade 3 obesity (body mass index ≥40 kg/m(2)) prior to bariatric surgery.We assessed 116 patients for childhood and adult ADHD, co-occurring psychiatric disorders, severity of depression and daytime sleepiness.Fourteen participants (12.1%) screened positive for adult ADHD. Even though this rate is higher compared with prevalence rates in representative population samples, it was not elevated compared with a group of morbidly obese individuals in a German general population sample (14.3%). Adult ADHD was associated with greater severity of depressive symptoms and more psychotherapy contact in the past but not with binge eating disorder or daytime sleepiness.As ADHD appears to be a common condition in morbidly obese individuals, the impact of adult ADHD on postsurgical weight loss needs to be examined. Besides, the causal link between obesity and ADHD in adults should be further investigated.

The objective of this study was to investigate the relationship between binge eating and temperament variables, controlling for depression and adult attention deficit/hyperactivity disorder (ADHD), in 90 extremely obese individuals. The participants completed questionnaires assessing eating pathology, reactive temperament, effortful control, depression and ADHD and were grouped based on the presence of regular binge eating. Patients reporting regular binge eating did not differ from patients not reporting regular binge eating with respect to BMI, age, gender, the occurrence of adult ADHD and reactive temperament. However, individuals with binge eating exhibited more pathological scores with regard to eating pathology, depression and effortful control. A logistic regression analysis revealed that only eating concerns and reduced effortful control remained significantly associated with regular binge eating. Binge eating in morbidly obese individuals appears to be associated with a lack of effortful control.

Objective: We aimed at exploring the expression of neuropeptide Y (NPY), omentin and visfatin in adipose tissues of adults along with clinical parameters and hormones. Methods: We included 168 adult patients (31 surgical obese patients and 31 surgical controls, 76 non-surgical obese patients, 30 non-surgical controls). We measured plasma NPY (by radioimmunoassay), cortisol (with an electrochemiluminescence immunoassay) and urinary cortisol metabolites (by gas chromatography/ mass spectrometry). Expression of NPY, omentin and visfatin in subcutaneous and visceral adipose tissue specimens of the surgical patients was quantified using real-time PCR. Results: NPY was detectable in adipose tissue specimens and, like plasma NPY concentrations, comparable between groups. Omentin gene expression was higher in visceral than in subcutaneous adipose tissues (p < 0.0001). Visfatin expression was lower in the subcutaneous tissue of obese patients compared with controls (p < 0.05). Cortisol was lower in obese adults compared with controls (136.5 ± 74.1 vs. 162.2 ± 56.1 ng/ml; p < 0.05), cortisol metabolites were comparable between groups. Conclusion: In our obese adults, plasma NPY levels and the glucocorticoid measures were not elevated. Even though the expression of NPY, omentin and visfatin was comparable between obese individuals and controls, we have to consider differences in the total production rate of adipose tissue-derived factors.

The goal of the study was to determine the concordance between mental disorder assessed during clinical evaluation and those independently obtained by a SCID interview in morbidly obese patients prior to bariatric surgery. In 116 patients a SCID interview was conducted. The agreement was moderate for any current diagnosis (kappa 0.43) current affective disorder (kappa 0.41) and current eating disorders (kappa 0.47). For current anxiety disorders agreement was poor wit a kappa of 0.11. For anxiety disorders and eating disorders the use of SCID resulted in more diagnoses than did standard clinical evaluation. Generally, the SCID produced more current axis 1 diagnoses than the clinical evaluation. When conducting a clinical evaluation prior to bariatric surgery a structured clinical interview should be used to assess mental co-mobidity.

Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

The objective was to compare two methods for assessing eating disorder psychopathology in pre-gastric banding surgery patients. 93 morbidly obese patients were assessed with the German versions of the Eating Disorder Examination (EDE) and the Eating Disorder Examination-Questionnaire (EDE-Q). The EDE and the EDE-Q were significantly correlated on the restraint, eating concern, shape concern and weight concern subscales, although the questionnaire scores were significantly higher. Frequencies of objective bulimic episodes were slightly but significantly correlated and the difference between EDE and EDE-Q was not significant. When participants were classified as binge eaters based on a cut-off of two binges per week on average in the last 28 days, the concordance between EDE and EDE-Q was moderate. The EDE-Q seems well-suited in assessing eating disorder psychopathology in obese pre-gastric banding patients. Yet, for the assessment of binge eating episodes the use of the questionnaire alone can not be recommended.