– more than merely weight loss
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
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.