Anatomy - Laparoscopic sleeve gastrectomy - general and visceral surgery
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The incidence and prevalence of morbid obesity and its associated comorbidities is increasing worldwide, particularly in Western countries. According to the WHO, 600 million people worldwide are obese (BMI > 30 kg/m2).
As evidenced by high-quality data, bariatric and metabolic surgical procedures are the most effective and long-lasting treatment modalities in morbid obesity and outperform nonsurgical multimodal regimens.
In addition to achieving sustained weight loss, surgery can also successfully treat obesity-related comorbidities, such as type 2 diabetes mellitus (T2DM); sleep apnea and other disorders of ventilatory control; obesity-related cardiomyopathy and hypertension; hyperlipidemia; pseudotumor cerebri; orthopedic damage to the knees; spinal problems; stress incontinence; polycystic ovary syndrome; and infertility. It is scientifically proven that massive weight reduction prevents or results in relative improvement or even remission of obesity-associated somatic diseases.
The proliferation and acceptance of bariatric surgery has increased significantly worldwide over the past 20 years (approx. 150,000 procedures in 2003, 470,000 in 2013).
The main pathophysiological mechanisms are restriction, malabsorption, and the combination of both.
Hormonal effects play an important role in all procedures eliminating food from the gastroduodenal passage and/or resecting gastric volume. As 80% of ghrelin receptors (hunger hormone) are located in the stomach, elimination/resection will result in less hunger signaling to the brain.
The large number of complex changes with metabolic effects unfolding in the enterohumoral axis because of surgery go well beyond weight loss.
The new term “metabolic surgery” reflects this expanded indication. Bariatric surgery is expected to play an increasingly important role in the management of metabolic syndrome.
Many patients with T2DM undergo complete remission already within days of surgery and long before significant weight loss. The current discussion has evolved to the issue of treating normal weight and slightly overweight diabetics by metabolic surgery as well.
With the advent of laparoscopic surgical techniques, these procedures, initially regarded as high-risk surgery, can now be performed with an acceptable risk profile.
Bariatric and metabolic surgery is not covered by the Standard Benefits Catalog of the German Statutory Health Insurance providers. Therefore, each patient must apply individually to his/her provider for this type of surgery.
Sleeve gastrectomy (SG)