Which surgical procedure is used for an obesity patient is always an individual decision. The decision-making process depends on numerous factors such as weight, age, accompanying diseases, psychosocial stress and social environment.
In order for the patient to be included in the decision, the advantages and disadvantages of the various surgical options must be discussed with him. The following points are important for the choice of procedure:
- the height of the initial weight
- patient's expectations of the procedure
- the previous eating behaviour of the patient
- the risk profile of the patient
- expected weight loss due to bariatric surgery
- influence of the procedure on the obesity-related diseases of the patient, in particular, diabetes mellitus type 2
- the willingness of the patient to consistently carry out the necessary lifelong aftercare
The patient's willingness to cooperate can be assessed on the basis of previous diets and exercise programmes. Age, occupation, regular medication and social environment also play a role in the decision opting for a particular surgical technique. The choice of procedure depends not only on the patient's eating habits but also on obesity-related concomitant diseases. This is because not only weight reduction is in the focus, but also the improvement of accompanying and secondary illnesses, which are not equally good in all surgical procedures.
Patients with extreme obesity may also need to undergo several procedures. A two-stage concept could, for example, be that the patient first receives a gastric balloon. Balloon therapy leads to a short-term reduction in weight, which leads to an improvement in accompanying illnesses, which in turn reduces the risk of complications that can occur during the actual bariatric operation.
The surgeon, internist, psychosomatist, nutritional therapist and of course the patient should be involved in deciding which surgical procedure is most suitable.
Bilbiography sources:
Deutsche Adipositas-Gesellschaft, Deutsche Diabetes Gesellschaft, Deutsche Gesellschaft für Ernährung, deutsche Gesellschaft für Ernährungsmedizin (2014) Interdisziplinäre Leitlinie der Qualität S3 zur „Prävention und Therapie der Adipositas“. AWMF-Register Nr. 050/001. Klasse: S3. Version 2.0.
Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Chirurgische Arbeitsgemeinschaft für Adipositastherapie (CAADIP), Deutsche Adipositas-Gesellschaft (DAG), Deutsche Gesellschaft für Psychosomatische Medizin und Psychotherapie, Deutsche Gesellschaft für Ernährungsmedizin (2010) S3-Leitlinie: Chirurgie der Adipositas.
Hüttl TP (2014) Adipositaschirurgie – Indikation, Operationsverfahren und Erfolgsaussichten. Klinikarzt 43: 198–204
Runkel N, Colombo-Benkmann M, Hüttl TP, et al. (2011) Bariatric Surgery. Dtsch Arztebl Int 108: 341–346
