A common and effective surgical procedure for morbid obesity is : Obesity or bariatric surgery is a treatment option for patients who were unable to achieve adequate weight loss in conservative (non-operative) treatment programs. The University Hospital Leipzig is a certified reference center for bariatric surgery.
The Department of Obesity and Metabolic Surgery at Leipzig University Hospital received the certification as a reference center for bariatric surgery in 2017. This confirms the special expertise and quality of treatment of the center.
The obesity or bariatric surgery at the University Hospital Leipzig is integrated into a broad network of doctors and therapists, which offers optimal advice and treatment for patients with obesity. In close cooperation with the IFB, both conservative (non-surgical) and surgical treatment options for obesity are offered and implemented and scientifically monitored by a multidisciplinary team of internists, surgeons, nutritional therapists and psychologists. If one patient has exhausted all options for conservative treatment without sufficient success, gastroenterologists and surgeons at Leipzig University Hospital offer a wide range of endoscopic and surgical weight loss procedures (see below).
The established care and aftercare concept is offered by the physicians, nutritional therapists and psychologists of the IFB Obesity Outpatient Clinic and plays a key role in the long-term care of bariatric patients with the goal of optimal and sustained weight loss. The preparation for a bariatric procedure includes the reports for the cost transfer application to the health insurance, all relevant preliminary examinations as well as comprehensive information about the procedure and an individual nutrition training. After the surgery, the patients are closely followed up in the IFB Adiposity Outpatient Clinic (see also ‘Aftercare’).
Requirements for surgery of obesity surgery
For the treatment of obesity with surgical procedures there is a medical guideline in Germany ( AWMF guideline “Surgery of obesity and metabolic diseases” ), which was created under the chairmanship of Prof. Dietrich.
When certain criteria are present in a patient who advocates an obesity surgical or metabolic operation, physicians speak of an indication for such an intervention. Reasons against obesity surgery are called contraindications.
Indications are divided into obesity and metabolic procedures.
surgery Bariatric surgery is an operative procedure (eg, tubing development) that aims to improve comorbidities and their prophylaxis and improve their quality of life through sustained weight reduction.
The indication for bariatric surgery is given under the following conditions:
- In patients with a BMI ≥ 40 kg / m2 without concomitant diseases and without contraindications, after exhaustive use of conservative therapy, after a comprehensive education an obesity surgery is indicated.
- Patients with a BMI ≥ 35 kg / m2 with one or more obesity-associated comorbidities such as type 2 diabetes, coronary heart disease, heart failure, hyperlipidemia, arterial hypertension, nephropathy, obstructive sleep apnea syndrome (OSAS), obesity hypoventilation syndrome, Pickwick syndrome, non-alcoholic Fatty liver (NAFLD) or non-alcoholic fatty liver hepatitis (NASH), pseudotumor cerebri, gastroesophageal reflux disease (GERD), asthma, chronic venous insufficiency, urinary incontinence, immobilizing joint disease, fertility limitations or polycystic ovarian syndrome should be offered an obesity surgery when conservative therapy is depleted is.
- Under certain circumstances, a primary indication may be made for a bariatric surgery without a prior conservative therapeutic attempt. The primary indication can be given if any of the following conditions are met:
• in patients with a BMI ≥ 50 kg / m2
• in patients for whom a conservative treatment attempt by the multidisciplinary team was considered unsuccessful
• in patients with particular severity of concomitant and sequelae that do not allow postponement of surgery
When a so-called primary indication is set, the operation is immediate. In advance, an evaluation must be carried out by all members of the treatment team. There must also be a diet change in favor of the intervention (including regular meals, avoidance of sugary drinks), detailed information about the operation and expected life changes. Contraindications must not exist.
Definition of fatigue in conservative therapy
Conservative measures are considered to be exhausted if at least 6 months of comprehensive lifestyle intervention have led to a reduction in the starting weight of> 15% at a BMI of 35-39.9 kg / m² over the last two years and> 20% at a BMI above 40 kg / m² was not achieved.
An indication is also given if the above weight reduction could be achieved by conservative measures and persisting obesity-associated diseases can be further improved by obesity surgery or metabolic surgery.
If after a successful weight reduction again a weight increase of> 10%, the conservative therapy after one year is also considered exhausted.
Metabolic surgery is understood to mean surgical interventions (as in bariatric surgery) when the indication is primarily for the improvement of the glycemic metabolic state in pre-existing type 2 diabetes.
The indication for metabolic intervention is given under the following conditions:
- From a BMI ≥ 40 kg / m² and coexisting type 2 diabetes, a metabolic operation should be recommended to the affected person as a possible therapy option, independent of the glycemic control or the complexity of the antidiabetic medication. In addition to the antidiabetic effect, the patient also has the positive effects of sustained weight loss.
- For those with a BMI ≥ 35 kg / m² and <40 kg / m² and co-existing type 2 diabetes, metabolic surgery should be recommended as a potential therapeutic option if the diabetic-specific individual target values under the National Treatment Guideline for Type 2 To reach diabetes.
- Metabolic surgery should be considered as a possible treatment option for adults with a BMI ≥ 30 kg / m² and <35 kg / m² and co-existing type 2 diabetes, if the diabetic-specific individual target values according to the National Care Guideline for Type Therapy are not met. To achieve 2 diabetes.
- Metabolic surgery for adults with a BMI <30 kg / m² and coexisting type 2 diabetes should only be done in scientific studies.
- For patients of Asian origin, the BMI limit is 2.5 points lower.