Surgical therapy
The surgical therapy of morbid adiposity (BMI >40 kg/m2), so-called bariatric surgery, is far superior to conventional therapy methods. This applies to the extent of weight reduction as well as to prevention of secondary diseases. Thus, surgical therapy in the long term will decrease direct and indirect costs of health care. According to conventional measures surgical therapy is symptomatic – and not causal. Each surgical intervention represents a definite solution, which must be treated again only in case of complications. This is especially evident in reversible surgical techniques, e.g. gastric banding: after reconstruction of the original anatomic conditions, patients will regain weight quickly, until the original weight is achieved or even exceeded.
Aside from weight criteria, other requirements must be met as well (see Indication - Contraindication ), in order to choose surgical treatment. The acceptance of bariatric therapy approaches is in part to be credited to the “International Federation for the Surgery of Obesity” (see International Federation for the surgery of obesity).
Surgical interventions aiming at weight reduction either decrease size of food portions by restriction of stomach volume (restrictive procedures) or reduce the absorption of nutrients in the small bowel (malabsorptive procedures). Malabsorptive procedures are usually combined with various restrictions of the stomach.
The operation itself represents merely the beginning of morbid adiposity therapy, and not the completion as usual with other surgical interventions. Bariatric surgery requires high quality personnel and structural resources (see The Team), to guarantee effective cooperation with other departments, and the ability to guarantee required lifelong control and care to patients. Regarding the outcome differentiated and prospective data collection should ensure continuous monitoring of structural-, progress-, and result quality, thus optimisations can be made as required.
Criteria to evaluate the success are perioperative complication rates, loss of excess weight, healing of secondary diseases, improvement of life quality, and improved cost control (cp. Table 9).
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| Tab. 9: Therapy goals | |||