Morbid obesity with its associated comorbidities shows an increasing incidence and prevalence worldwide, particularly in the Western world. According to the WHO, 600 million people are obese (BMI > 30 kg/m2).
Bariatric and metabolic surgical procedures are, as evidenced by high-quality data, the most effective and sustainable treatment methods for morbid obesity and are superior to conservative multimodal therapies.
In addition to long-lasting weight reduction, the comorbidities associated with obesity can also be successfully treated. These include primarily sleep apnoea and other ventilation disorders, type II diabetes mellitus, obesity-related cardiomyopathy and hypertension, dyslipidaemia, pseudotumor cerebri, orthopaedic damage to the knees, spinal problems, stress incontinence, polycystic ovary syndrome, and infertility. It is scientifically proven that massive weight reduction leads to prevention, relative improvement, or even remission of obesity-associated somatic diseases.
The spread and acceptance of bariatric surgery have increased significantly worldwide over the past 20 years (2003 approx. 150,000; 2013 470,000 procedures).
The most important pathophysiological mechanisms are restriction, malabsorption, and the combination of both.
Hormonal effects play an important role in all procedures that exclude food from the gastroduodenal passage and/or resect gastric volume. 80% of ghrelin receptors (hunger hormone) are located in the stomach, so that by exclusion/resection, fewer hunger signals are sent centrally.
Through a multitude of complex changes in the entero-humoral axis with metabolic effects, the consequences of surgical measures extend far beyond weight loss.
The newly coined term "metabolic surgery" denotes the expanded indication. It is expected that bariatric surgery will gain increasing importance in the management of the metabolic syndrome.
Many patients with type II diabetes mellitus show complete remission of the disease just a few days after surgery, long before significant weight loss has occurred. It is now being discussed whether "metabolic surgery" should also be used in diabetics who are of normal weight or slightly overweight.
Procedures initially considered high-risk surgery can now be performed with a manageable risk of complications following the introduction of laparoscopic surgical techniques.
Bariatric-metabolic operations are not included in the standard benefits catalogue of the German health insurance funds. Therefore, an individual application procedure must be initiated for each patient in order to perform such an operation.