Bariatric surgery is a subspecialty of visceral surgery and includes all recognized measures to combat morbid obesity, which include gastric banding, as well as the tubular stomach, gastric bypass and biliopancreatic diversion with duodenal switch. The prerequisite for obesity surgery is, in addition to a body mass index above 40, above all the unsuccessful exhaustion of conservative methods for weight reduction, but also concomitant diseases and age parameters must be taken into consideration. Patients are counseled in institutions specially certified for this purpose, and competent care is also required after surgery, since the patient must, for example, change his or her diet in order to benefit permanently from the surgical alteration of his or her gastrointestinal tract.
What is bariatric surgery?
Bariatric surgery is a subspecialty of visceral surgery and includes all of the recognized procedures used to combat morbid obesity, which include gastric banding, as well as the tubular stomach, gastric bypass, and biliopancreatic diversion with duodenal switch. The term obesity surgery or bariatric surgery covers all surgical procedures to combat morbid obesity. As a specialty of visceral surgery, bariatric surgery deals in particular with the gastrointestinal tract. In the course of bariatric surgery, obesity is thus counteracted by surgical changes to the gastrointestinal tract. This makes bariatric surgery the most invasive method of weight loss, while helping to minimize the risk of secondary diseases. The four accepted standard procedures of this surgical direction are gastric banding, biliopancreatic diversion with duodenal switch, gastric bypass, and tubular stomach. While gastric banding, gastric bypass, and tubular stomach by themselves limit the maximum intake of food, biliopancreatic diversion with duodenal switch limits the maximum intake of certain dietary ingredients.
Function, effect, and goals
The goal of any bariatric surgery is to restrict food intake or nutrient absorption, making it easier for the patient to lose weight and thus helping to prevent secondary diseases. Gastric banding is one of the best known and most popular methods of bariatric surgery, as it can be completely removed after a certain period of time. In this procedure, the stomach diameter is narrowed in the entrance area by the doctor applying a silicone band to the stomach fundus in the course of laparoscopic surgery and creating an entrance in front of the sternum or in the abdominal wall. Gastric bypass, on the other hand, involves the use of a miniaturized stomach that the physician connects to a loop of the small intestine. A different section of the small intestine henceforth traps the digestive juices. In a biliopancreatic diversion with duodenal switch, again a gatekeeper mechanism in the stomach prevents the tumbling of sugar and thus the rise in blood sugar. In this procedure, the duodenal stump is sealed off, with the physician connecting the duodenum to the ileum. The fourth and last method of bariatric surgery recognized as a standard procedure is the tubular stomach. This procedure ultimately belongs to gastroplasty and has become known as the first step of the so-called two-step method. In this procedure, the physician resects the stomach along the curvature, which leaves a tubular stomach remnant that is significantly smaller in volume than the actual stomach. The doctor removes the severed portion of the stomach completely. Suturing is usually done laparoscopically. After this surgical change of the stomach to a tubular stomach, the first weight reduction occurs, and the patient is assisted in approaching the final target weight two years after the procedure by a Scopinaro biliopancreatic diversion. The actual path of food passage is not altered with this method, although endoscopic procedures in the stomach tube are also within the realm of possibility. Because gastric bands are removed after a period of time to keep the risk of infection and slippage low, bariatric surgeons often combine the gastric band procedure with the tube stomach in the long run. This means that when surgery is performed to remove a gastric band, a tube stomach is often placed at the same time.Which bariatric surgery procedure is used in each case depends on the patient’s personal goals and desires, as well as the form of obesity.
Risks, side effects, and hazards
An obesity surgery procedure is always preceded by an expert consultation by an institution approved for this purpose. There are now certified centers of reference, competence and excellence in Germany for this purpose. The prerequisites for an obesity surgery include a body mass index over 40 or a BMI over 35 combined with concomitant diseases such as diabetes mellitus or arterial hypertension. The morbid form of obesity must also have existed for at least three years and the patient should have a biological age between 18 and 65 years. Conservative methods such as a multimodal therapy program with nutritional counseling and exercise training must have been completely exhausted in advance. In addition, the patient must not have any profound psychoses or addiction problems. The actual risks of the procedure are strongly related to the chosen method and the patient’s own constitution. However, since obesity generally has a negative impact on the risk of anesthesia and surgery, interventions are nowadays performed laparoscopically or in the form of the NOTES or SILS technique, as far as possible. This means that current bariatric surgery is associated with significantly fewer complications than was the case a few years ago. In addition to weight, the procedures of this surgical direction also change the patient’s general state of health for the better, since morbid obesity is always associated with negative effects on the general state of health. However, every bariatric surgery requires a consistent change of diet afterwards. Up to now, bariatric surgery has not been included in the standard catalog of health insurance companies. Nevertheless, in individual cases, the insurance companies will cover the costs incurred if the patient applies for coverage with good justification.
