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).
Obesity and metabolic surgical interventions are, supported by high-quality data, the most effective and sustainable treatment methods for morbid obesity and 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 apnea and other ventilation disorders, type II diabetes mellitus, obesity-related cardiomyopathy and hypertension, dyslipidemia, pseudotumor cerebri, orthopedic 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 main 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 stomach volume. 80% of ghrelin receptors (hunger hormone) are located in the stomach, so that by exclusion/resection, fewer hunger signals are sent centrally.
The consequences of surgical measures go far beyond weight loss through a multitude of complex changes in the entero-humoral axis with metabolic effects.
The new term "metabolic surgery" denotes the expanded indication. It is expected that bariatric surgery will gain increasing importance in the management of 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 to use "metabolic surgery" also in diabetics who are normal and slightly overweight.
The procedures initially considered high-risk surgery can now be performed with manageable complication risk due to the introduction of laparoscopic surgical techniques.
Bariatric-metabolic operations are not included in the standard service catalog of German health insurance companies. Therefore, an individual application procedure must be initiated for each patient to perform such an operation.