Bariatrische Chirurgie: Erwartungshaltung und Therapieziele – ein Gegensatz?

Abstract

In the majority of patients with morbid obesity, metabolic/bariatric surgery leads to relevant and sustained weight loss and improves obesity-related comorbidities, quality of life and functionality. Moreover, the associated reduction of risk factors for cardiovascular events and cancerous diseases has been shown to improve life expectations. Due to its excellent antidiabetic effect, the currently valid national S3 guidelines now recommend metabolic/bariatric surgery in patients who have a body mass index (BMI) ≥30 kg/m with poorly controlled diabetes. The Edmonton staging system enables a multidimensional consideration of the severity grade of obesity for each individual patient independent of the BMI. Patients with relevant obesity-related metabolic comorbidities should be prioritized for treatment and if possible before the occurrence of end-organ damage that is at least in some cases irreversible and which also increases the perioperative risk. Therapeutic goals for each individual patient should be carefully defined preoperatively in order to mediate realistic expectations. Unrealistic expectations, such as "surgery solves my problems", "surgery makes me more beautiful", "surgery eliminates stigma", and "surgery guarantees success", are common in bariatric surgery patients. These unrealistic expectations can lead to frustration and to severe psychological decompensation and need to be addressed as early as possible by an interdisciplinary team. Redundancies, conclusive and empathic communication in the team improve therapy adherence, the expectations and therefore the overall outcome.

Sexuality amongst heterosexual women with morbid obesity in a bariatric surgery programme: A qualitative study

“…Low self‐esteem is an indicator of despair amongst patients included in a bariatric surgery program, (Gaudrat et al, 2021). Therapeutic objectives should be defined for each individual patient prior to bariatric surgery, and realistic expectations should be laid out (Hering et al, 2018). Although people with MO worry about excess skin after bariatric surgery (Kabu & Özbayır, 2021), the participants address this after the intervention as their key focus is weight loss.…”

“…Women with MO hope to improve their sexual and reproductive health following bariatric surgery, which is associated with a consequent improvement in self‐esteem and body image (Nilsson‐Condori et al, 2020). Significant weight loss as a result of bariatric surgery can improve sexual dysfunction in women (Pichlerova et al, 2019), but unrealistic expectations can lead to frustration (Hering et al, 2018). Research into FSD in MO women has focused on diagnosis, treatment and psychological effects.…”

Aktuelle Aspekte der Verfahrenswahl bei Adipositas-Chirurgie

“…Das Operationsverfahren muss im Vorfeld durch ein erfahrenes und interdisziplinäres Team auf den individuellen Patienten angepasst und präoperativ mit dem Patienten ausführlich bezugnehmend auf die jeweiligen Vor-und Nachteile besprochen werden. Hier müssen mit dem Patienten die jeweiligen prozedurspezifischen Vor-und Nachteile, postoperativ notwendige Verhaltensmaßgaben sowie Nachsorgeintervalle und insbesondere realistische Therapieziele mit realistischen Erwartungshaltungen besprochen werden [63,64].…”