HELIOS International

Bariatric surgery – more than merely weight loss

For years the Berlin-based specialists Prof. Dr. Jürgen Ordemann and Prof. Dr. Michael Ritter have been successfully treating obese patients conservatively and surgically. They are aware of the prejudices and restrictions which those affected have to struggle with. Obesity is a transboundary problem: no other disease spreads so strongly and quickly – the WHO refers to a global obesity epidemic. In some countries, a normal weight has already become an exception and overweight has become the rule. “The consequences are catastrophic”, says Professor Ordemann, “mortality is rising while life expectancy is decreasing, and concomitant diseases such as type 2 diabetes mellitus, sleep apnoea syndrome, infertility as well as cardiovascular and tumour diseases are increasing.” Obese patients often no longer manage to reduce their weight on a long-term basis. “From a considerable extent of overweight, genetic causes and metabolic changes bring about a poor prognosis, not the ‘weakness of character’ or ‘laziness’ of those affected. Today we know that surgical measures can break the cycle”, explains Professor Ritter. Numerous studies show that surgical therapy constitutes the only effective and above all sustainable treatment for obesity. Metabolic sequelae are substantially improved, frequently even healed – this explains why the medical discipline is also called ‘metabolic surgery’. “According to our experience, the quality of life among operated patients increases immediately, while mortality decreases substantially compared to obese patients who did not have the surgery”, says Ordemann. The most common bariatric surgery procedures are the following:

Experts place the gastric bypass in a minimally invasive procedure
First a small stomach pouch (20-30 ml) is placed on the cardia and separated from the remaining stomach. The small intestine is subsequently severed in the upper segment and connected with the stomach pouch. Food enters this significantly shortened section of the small intestine, whereby the nutrient absorption otherwise occurring in another section is omitted. Instead, only bile and digestive enzymes from the pancreas are transported here. Further below the loop is reconnected to the small intestine. The weight loss anticipated through the gastric bypass is up to 80% of excess weight. In addition, hormonal and neuronal changes are decisive for the success.

The placement of a sleeve gastrectomy also occurs laparoscopically
In the process, two thirds of the stomach are resected, i.e. removed. The remaining stomach encompasses about 80-120 ml, has the shape of a sleeve and roughly the size of a banana. The sleeve gastrectomy extends from the oesophagus to the pyloric orifice and is further accessible by means of endoscopic examination methods. With the removal of stomach tissue, not only a reduction in the size of the stomach occurs, but also an appetite- curbing effect. Neuronal control elements – which have a direct influence on the pivotal metabolic centres – also seem to be activated with the procedure. The operation takes 30 to 60 minutes and is performed under general anaesthesia. Patients can lose up to 75% of their excess weight. Among those affected from warmer countries, the necessarily increased intake of fluids is to be heeded. That is why the sleeve gastrectomy is usually preferred to the gastric bypass in a common conversation.

Both procedures reduce the size of the stomach (restriction) and ensure a desired maldigestion (malabsorption). The origins of bariatric surgery were solely designed to reduce the energy intake of patients and thereby to enable a severe weight loss. “Meanwhile we know that the effect of an operation is considerably more comprehensive. Clinical and experimental studies push restriction and malabsorption into the background. Complex physiological mechanisms are more important”, emphasises Professor Ordemann. “The altered digestive anatomy leads to diverse biophysiological processes. Thus an altered release or the blockage of specific intestinal hormones – which seem to have an exclusive role in the hunger and satiety system – comes about. Immediately after the operation, patients have less appetite andrapidly have the feeling of satiety.” Despite less hunger, most patients experience an increase in their energy turnover. “After a surgical procedure, diets are no longer perceived as an ordeal, but as a normal condition”, adds Professor Ritter. All these mechanisms lead to the fact that seriously ill, obese patients can reduce their weight for the first time on a long-term basis – this enables active participation in life, while self-esteem and quality of life are considerably enhanced.



Date of upload: 22nd May 2017

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