Methods of bariatric surgery
Bariatric surgery (from Greek “báros”, heaviness, weight) is a specialty of abdominal surgery. The aim of the operations is solely weight reduction in cases of severe obesity. In all operations, the volume of the stomach is reduced. In addition to stomach reduction, sometimes more extensive procedures are performed on the intestines.
Studies indicate that the weight reduction achieved in this way not only has a cosmetic effect, but also has very beneficial effects on the entire 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. There is also evidence of a beneficial effect on other diseases associated with obesity, such as high blood pressure or elevated blood lipid levels.
For stomach reduction, the following criteria should be met:
- All non-surgical (conservative) measures such as a 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 above 40kg/m² or between 35 and 40kg/m² and diseases have already occurred due to the weight, for example diabetes, sleep apnea, high blood pressure, etc. @ The obesity has been present for at least six years.
- The overweight has existed for at least three years.
- The patient is between 18 and 65 years old. For patients with an age > 65 years, bariatric surgery can only be considered in exceptional cases.
- The patient is willing to maintain an active lifestyle with a varied diet after surgery.
The following criteria speak against gastric reduction:
- The patient has a known history of cancer.
- A treatable physical disease (for example, hypothyroidism) or psychological disorder is responsible for the obesity.
- The patient suffers from a previously untreated eating disorder.
- Some previous operations or previous damage to the gastrointestinal tract may make surgery difficult or impossible.
- There is an alcohol, drug or medication addiction.
Methods of stomach reduction
Bariatric surgery (bariatric surgery) nowadays 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 with the use of the keyhole technique (laparoscopic surgery). Keyhole technique means that large abdominal incisions are no longer necessary. Instead, instruments are inserted into the abdomen through usually three small incisions.
A small camera with an integrated light source is inserted through one of the incisions, allowing the surgeon to see the surgical area and the inserted instruments on a screen. The keyhole technique offers the advantage that less tissue is injured and thus healing is faster. The keyhole technique cannot sometimes be used if so-called adhesions (adhesions) have formed in the abdominal cavity due to previous operations.
Restrictive means that the procedure reduces the stomach capacity (stomach reduction) and a feeling of satiety occurs after only small portions of food. As a result of the reduction in food intake achieved in this way, weight is steadily reduced. In malabsorptive procedures, on the other hand, the digestive tract is surgically altered in such a way that malabsorption (impaired absorption) of food deliberately occurs. This is achieved by delaying the breakdown of nutrients and thus reducing the available absorption area of the gastrointestinal tract. The maximum amount of nutrients that can be absorbed into the blood decreases as a result.
Effectiveness of the surgical procedures with gastric reduction
The various techniques differ significantly in their effectiveness and the severity of the surgery. The effectiveness is evaluated mainly in terms of the weight loss that can be achieved with it, more precisely, according to the Excessive Weight Loss (EWL) achieved.
A calculation example: If a patient has a BMI of 45 kg/m² before surgery, this is 20 kg/m² above normal weight (= maximum 25 kg/m²). If this patient achieves a reduction of his BMI by 10 kg/m² to ultimately 35 kg/m² as a result of the operation, this corresponds to a weight loss of 50 percent of the excess weight.
In contrast to the effectiveness, however, clear statements can be made about the severity of the operation. The more pronounced the intervention changes the normal anatomy, the more often more serious complications occur. Basically, people with obesity always have an increased surgical risk.
The four most common surgical procedures and their effectiveness:
- Gastric banding (purely restrictive procedure), excess weight loss of up to 50 percent.
- Tubular stomach (purely restrictive procedure) excess weight loss up to 60 percent.
- Roux-Y gastric bypass (restrictive-malabsorptive procedure) excess weight loss 60 to 70 percent
- Biliopancreatic diversion with or without duodenal switch (restrictive-malabsorptive procedure), excess weight loss up to 52 to 72 percent
A non-surgical procedure is the so-called gastric balloon – a mostly liquid-filled silicone balloon that partially fills the stomach. It is not inserted with surgery, but in the course of a gastroscopy and is therefore not counted among the procedures of bariatric surgery in the narrower sense.
Stomach reduction: costs
The costs for the various methods of stomach reduction differ considerably. The assumption of costs is not yet a standard benefit of the statutory health insurance (GKV). This means that a stomach reduction, or a bariatric operation in general, is only covered by statutory health insurers if certain criteria are met on application. Such an application for cost coverage is filled out together with an “authorized physician” (usually a family doctor) and must be sent directly to the respective health insurance company. This often forwards it to the Medical Service of the Health Insurance Funds (MDK), which examines the request and either approves or rejects the assumption of costs for stomach reduction.
