stomach stapling

Methods of bariatric surgery

Bariatric surgery (from Greek “báros”, weight, weight) is a specialty of abdominal surgery. The goal of the surgery is a weight reduction in case of severe obesity. In all operations, the volume of the stomach is reduced. In addition to the gastric reduction, even more extensive interventions in the intestine are carried out.

Studies suggest that not only does the resulting weight reduction result in a cosmetic effect, but also has a very beneficial effect on the overall metabolism (metabolism). For this reason, bariatric surgery is now often referred to as “metabolic surgery”. For example, in many diabetics, blood glucose levels improve dramatically as a result of weight loss. A favorable influence on other diseases associated with obesity, such as hypertension or elevated blood lipid levels, can also be demonstrated.

Surgery for the treatment of obesity is generally considered only if other treatments could not achieve sufficient weight loss. Minimizing the stomach, like any surgery, involves certain risks and is irreversible. The operation should therefore be well considered.

For gastric reduction, the following criteria should be met:

• All non-surgical (conservative) measures such as the combination of nutritional counseling, exercise training and behavioral therapy have not brought sufficient success even after six to twelve months.
• The body mass index (BMI) is over 40kg / m² or between 35 and 40kg / m² and illnesses have already occurred due to weight, for example diabetes, sleep apnea, hypertension, etc.
• The overweight has existed for at least three years.
• The patient is between 18 and 65 years old. For patients over the age of 65, obesity surgery may be considered only in exceptional cases.
• The patient is prepared to maintain a movement-rich lifestyle with a varied diet even after the operation.

Against gastric reduction, the following criteria:

• The patient is aware of a cancer.
• Treatable physical illness (for example hypothyroidism) or mental disorder is responsible for obesity.
• The patient suffers from a previously untreated eating disorder.
• An overall high risk of surgery in general poor general condition.
• Some previous surgery or previous damage in the area of ​​the gastrointestinal tract may complicate an operation or make it impossible.
• There is an alcohol, drug or drug addiction.

Methods of stomach reduction

Today bariatric surgery (obesity surgery) offers a number of different surgical methods for the treatment of obesity. All procedures are performed under general anesthesia and can almost always be performed using the keyhole technique (laparoscopic surgery). Keyhole technique means that no large abdominal incisions are needed anymore. Instead, the instruments are placed over mostly three small cuts in the abdomen.

One of the entrances introduces a small camera with an integrated light source that allows the surgeon to see the operating area and instruments inserted on a screen. The keyhole technique has the advantage that less tissue is injured and thus the healing process is faster. The keyhole technique can sometimes not be used if so-called adhesions (adhesions) have formed in the abdomen due to previous operations.

Basically, a distinction is made between so-called restrictive and malabsorptive surgical principles:

Restrictive means that the intervention reduces gastric capacity (gastric reduction) and saturates even after small portions of food. The reduction in food intake thus reduces the weight steadily. In the case of malabsorptive procedures, on the other hand, the digestive tract is surgically modified in such a way that a malabsorption (intake disorder) of the food occurs deliberately. This is achieved by delaying the breakdown of nutrients and thus decreasing the available absorption area of ​​the gastrointestinal tract. The amount of nutrients that can be maximally absorbed into the blood decreases as a result.

Effectiveness of surgical procedures with gastric reduction

The different techniques differ considerably in their effectiveness and the severity of the operation. The efficacy is assessed primarily with regard to the weight loss achievable thereby, more precisely, according to the achieved excess weight loss (EWL).

It does not refer to the total weight before the procedure, but only to the amount above the normal weight BMI limit of 25 kg / m². If the excess weight loss is 50 percent, that does not mean that the body weight has been cut in half, but that half of the body weight has been halved excess Body weight has disappeared.

A calculation example: If a patient has a BMI of 45 kg / m² before the operation, this is 20 kg / m² above the normal weight (= maximum 25 kg / m²). Achieving this patient by the reduction of his BMI by 10 kg / m² to ultimately 35 kg / m², this corresponds to a weight loss of 50 percent of the excess weight. In contrast to the efficacy, however, clear statements can be made about the severity of the operation. The more pronounced the procedure changes the normal anatomy, the more frequently serious complications occur. Basically, people with obesity always have an increased surgical risk.

The four most common surgical procedures and their effectiveness:

• Gastric band (purely restrictive procedure), overweight loss up to 50 percent
• Tubular stomach (purely restrictive procedure) Overweight loss up to 60 percent
• Roux-Y gastric bypass (restrictive malabsorptive procedure) overweight loss 60 to 70 percent
• Biliopancreatic diversion with or without duodenal switch (restrictive malabsorptive procedure), overweight loss up to 52 to 72 percent

The Roux-Y Gastric Bypass and Biliopancreatic Diversion combine the two principles of action – reducing both the size of the stomach and delaying the breakdown of food. Further information on all four procedures can be found on the relevant pages.

A non-surgical procedure is the so-called gastric balloon – a mostly fluid-filled silicone balloon that partially fills the stomach. It is not introduced with an operation, but as part of a gastroscopy and therefore not counted in the strict sense to the procedures of obesity surgery.

Gastric reduction: costs

The cost of the various methods of gastric reduction vary considerably. The reimbursement of costs is so far no regular benefit of the statutory health insurance (GKV). This means that statutory health insurance companies will only accept a gastric reduction, or in general a bariatric surgery, upon application of certain criteria. Such a request for reimbursement will be filled out together with an “application-entitled doctor” (usually family doctor) and must be addressed directly to the respective health insurance company. This often forwards him to the medical service of the health insurance funds (MDK), which examines the issue and either a consent or a refusal to pay for the stomach stapling granted.