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Chirurgische Verfahren bei krankhafter Adipositas

Stellenwert und Langzeitergebnisse

Surgical procedures for severely obese patients: impact and long-term results

  • Schwerpunkt: Adipositas und Innere Medizin
  • Published:
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Zusammenfasung

Adipositas ist eine multifaktorielle, genetisch determinierte, neuroendokrine, chronische Erkrankung. Konservative Maßnahmen bei Patienten mit Adipositas Grad II–III mit einem BMI >35 kg/m2 haben langfristig nur bescheidenen Erfolg. Chirurgische Verfahren werden seit 1954 durchgeführt, die Methodik wird seitdem kontinuierlich optimiert. Bei rein restriktiven Verfahren kann eine Übergewichtsreduktion von rund 50%, bei zusätzlicher Malabsorption bis zu 75% langfristig erreicht werden. Alle Methoden bewirken eine deutliche Verbesserung in Bezug auf die Elimination der adipositasassoziierten Begleiterkrankungen und eine dramatische Verbesserung der Lebensqualität. In gut dokumentierten Langzeitstudien beträgt die perioperative Mortalität 0,2–1,0% je nach Verfahren, die Morbidität maximal 20%. Die adipositaschirurgischen Maßnahmen sind evidenzbasiert als sichere und effektive Maßnahmen anerkannt.

Abstract

Obesity is a multifactorial, genetically-determined, neuroendocrine, and chronic condition. Conservative treatment of patients with class II and III obesity (BMI >35 kg/m2) has only modest long-term success. Surgical procedures have been used since 1954, and the methods used are continually being updated and improved. With experienced surgeons, patients can achieve a weight reduction from around 50% with purely restrictive procedures, increasing to 75% with combined restrictive-malabsorptive methods. All weight-loss methods offer a considerable improvement or elimination of obesity-related co-morbidities and substantially improvement of quality of life. Well-documented, long-term studies reveal a perioperative mortality of 0.2–1.0%, dependent on the surgeon’s experience, and a maximum perioperative morbidity of 20%. Bariatric surgery is accepted as evidence based, safe and effective treatment of obesity.

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Authors and Affiliations

  1. Stoffwechselzentrum, Klinik Hirslanden, Zürich, Schweiz

    N. Potoczna, R. Steffen &  F.F. Horber

  2. Dr. Horber Adipositas Stiftung, Zürich, Schweiz

    N. Potoczna, R. Steffen &  F.F. Horber

  3. Adipositaszentrum, Klinik Lindberg, Winterthur, Schweiz

    F.F. Horber

  4. Stoffwechselzentrum, Klinik Hirslanden, Witellikerstraße 40, 8032 , Zürich, Schweiz

    F.F. Horber

Authors
  1. N. Potoczna
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  2. R. Steffen
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  3. F.F. Horber
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Correspondence to F.F. Horber.

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Potoczna, N., Steffen, R. & Horber, F. Chirurgische Verfahren bei krankhafter Adipositas. Internist 47, 150–158 (2006). https://doi.org/10.1007/s00108-005-1557-8

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  • DOI: https://doi.org/10.1007/s00108-005-1557-8

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