Gewachsene Erfordernisse im anspruchsvollen viszeralchirurgischen Management bei morbider Adipositas – Was muss der Viszeralchirurg wissen?^[*]

 

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Zusammenfassung

Die Bundesrepublik Deutschland gehört im internationalen und europäischen Vergleich zu den Ländern mit einer sehr hohen Prävalenz der Adipositas (67,1 % der Männer und 53 % der Frauen) wie auch europaweit hinsichtlich der Inzidenz des Diabetes mellitus Typ 2 („Studie zur Gesundheit Erwachsener in Deutschland“ [DEGS] – Robert Koch-Institut). Nicht nur für den Chirurgen stellt dieser Umstand eine Herausforderung bei gängigen viszeralchirurgischen Eingriffen dar. 1. Die Auswahl der für solche Patienten benötigten Ausstattung im OP-Saal bedarf einer Anpassung an das Übergewicht der Patienten. 2. Die minimalinvasive Chirurgie reduziert bei diesen Patienten nicht nur die Komplikationsrate an Wundinfekten und Hernien, sondern verbessert insbesondere die Beurteilung der Abdominalhöhle. 3. Eine Vielzahl minimalinvasiver Instrumente kann bei Normalgewichtigen und morbid Adipösen ohne Einschränkung eingesetzt werden – für konventionelle Eingriffe sollten jedoch Retraktorsysteme vorhanden sein. 4. Hinsichtlich der Notfallversorgung bariatrisch operierter Patienten sollte sowohl ein kompetentes Basiswissen zu den üblichen bariatrischen Operationen und daraus folgenden anatomischen Konstellationen als auch den Langzeitkomplikationen vorliegen. 5. Für zahlreiche onkologische Eingriffe wurden in Studien keine Unterschiede im Outcome von normalgewichtigen und morbid adipösen Patienten nachgewiesen.

Abstract

In the international comparison and in Europe, the Federal Republic of Germany belongs to the countries with a very high prevalence of obesity (men, 67.1 %; women, 53 %). Among the European countries, the incidence of diabetes mellitus type 2 is also high (“Study of the health of adults in Germany” [DEGS]) – Robert Koch Institute). Not only for surgeons, this can be considered as a great challenge even in usual abdominosurgical interventions. 1. Surgical equipment needs to be adapted to the requirements for obese patients. 2. Minimally invasive surgery reduces not only complication rates with regard to postsurgical wound infection and hernia in such patients, it allows a competent assessment of the peritoneal cavity. 3. A great number of surgical tools and instruments can be used in normal weight as well as morbidly obese patients with no limitations – for conventional (open) surgical interventions, retractor systems should be available. 4. With regard to emergency surgery in patients who had formerly undergone bariatric surgery, a competent basic knowledge on the usual bariatric surgical interventions and the subsequent anatomic consequences as well as the more frequent mid- and long-term complications is necessary, which need to be partially approached with the surgical intervention. 5. For numerous oncosurgical interventions, no differences in postoperative outcome were found between normal weight and morbidly obese patients.

^* Prof. Dr. Dr. H. Lippert gewidmet

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