Gewachsene Erfordernisse im anspruchsvollen viszeralchirurgischen Management bei morbider Adipositas - Was muss der Viszeralchirurg wissen?

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.

Beriberi, a Severe Complication after Metabolic Surgery - Review of the Literature

“…Not only bariatric surgeons but also all other physicians involved in the medical aftercare of such patients should be aware of the risks of vitamin, trace element and electrolyte deficiencies after bariatric surgery and how these deficiencies can be diagnosed and treated [ 9 , 10 ]. In case of clinical suspicion or deferred parenteral nutrition, the immediate introduction of a thiamine substitution is necessary to minimize the risk of catastrophic consequences.…”

“…Several studies have found a beriberi incidence prior to bariatric surgery procedures of approximately 15.5% [ 12 , 13 , 14 ]. In women, the thiamine level is lower than in men [ 9 ]. A retrospective analysis from the literature indicated that 29% of patients suffer from thiamine deficiency prior to bariatric surgery [ 15 ].…”

“…A delayed diagnosis or missing the correct diagnosis can lead to irreversible damages of the CNS with coma and fatal outcome. Knowledge on the subject, including development of thiamine deficiency, symptomatology and emergency treatment, can be considered essential for bariatric surgeons but also for other physicians involved in treatment after bariatric surgery [ 9 ].…”

Wernicke Encephalopathy: a Future Problem Even After Sleeve Gastrectomy? A Systematic Literature Review

“…Caucasians usually show a smaller incidence of low serum thiamine levels. In women, serum thiamine levels are lower than in men [25]. It has been reported that 5-30 % of patients undergoing bariatric surgery suffered from subnormal serum thiamine levels prior to the treatment [26,27].…”