This book presents the surgical therapy of obesity and metabolic diseases in a practice-oriented and detailed way. The specific surgical procedures with their indications, performance and risks are described precisely in words and pictures. Special emphasis is placed on the choice of the appropriate surgical procedure for the individual patient. In addition to the mechanisms of action, interdisciplinary preoperative evaluation of the patient and postoperative aftercare are explained. Furthermore, surgical, internal and psychosomatic complications and complication management are described. Information on obesity center organization and alternative bariatric therapies complete the volume.
This book is a translation of the original German 1st edition Adipositas- und metabolische Chirurgie by Jürgen Ordemann & Ulf Elbelt, published by Springer-Verlag GmbH Germany, part of Springer Nature in 2017. The translation was done with the help of artificial intelligence (machine translation by the service DeepL.com). A subsequent human revision was done primarily in terms of content, so that the book will read stylistically differently from a conventional translation. Springer Nature works continuously to further the development of tools for the production of books and on the related technologies to support the authors.
Author(s): Jürgen Ordemann, Ulf Elbelt
Publisher: Springer
Year: 2022
Language: English
Pages: 198
City: Berlin
Preface
Contents
Contributors
1: Obesity
1.1 Classification of Obesity
1.2 “Globesity”: The Current Pandemic
1.3 Why Are We Getting More and More Obese? Etiology and Pathophysiology
1.3.1 Food and Eating Habits
1.3.2 Lack of Physical Activity
1.3.3 Genetic Causes
1.3.4 Psychological Causes
1.3.5 Endocrine Causes
1.3.6 Drugs Promoting Weight Gain
1.4 Regulation of Hunger and Satiety in Obesity
1.4.1 Definition of Hunger and Satiety
1.4.2 Peripheral Mediators of Hunger and Satiety Regulation
Ghrelin
Nesfatin-1
Cholecystokinin
Pancreatic Polypeptide
Peptide YY
Glucagon-Like Peptide 1
Leptin
Insulin
Glucagon
1.4.3 Signalling from the Periphery to the Brain
1.4.4 Central Nervous Signal Integration
1.4.5 Psychological Constructs
Conclusion
1.5 Secondary Diseases of Obesity
1.5.1 Metabolic Syndrome
1.5.2 Diabetes Mellitus Type 2
1.5.3 Arterial Hypertension
1.5.4 Dyslipidemia
1.5.5 Cardiovascular Complications
1.5.6 Liver Disease
1.5.7 Obesity and Sleep-Related Breathing Disorders
1.5.8 Diseases of the Musculoskeletal System
1.5.9 Malignant Diseases
1.5.10 Other Obesity-Related Diseases
1.6 Psychosocial Aspects of Obesity
1.6.1 Stigmatisation of Obese People
1.6.2 Quality of Life
1.6.3 Stress
1.6.4 Depression
1.6.5 Anxiety Disorders
1.6.6 Neglect, Abuse and Post-traumatic Stress Disorder
1.6.7 Eating Disorders
1.6.8 Personality and Personality Disorders
1.6.9 Substance Abuse
1.6.10 Suicidal Tendencies
1.6.11 Social Inequality
References
1.1 to 1.3
1.5
Further Reading
1.4
1.5
1.6
2: Conservative Treatment of Obesity
2.1 Therapeutic Goals
2.2 Nutrition Therapy
2.3 Physical Exercise
2.4 Lifestyle Change: Psychotherapy and Psychoeducation
2.5 Drug Therapy
2.5.1 Orlistat
2.5.2 Liraglutide
2.5.3 Metformin
2.6 Multimodal Therapy Programmes
References
Further Readings
3: Surgical Therapy of Obesity
3.1 Frequency of Obesity Surgery
3.2 Therapeutic Goals and Evaluation Criteria
Conclusion
3.3 Indications for Surgical Treatment of Obesity
3.4 Obesity Surgical Procedures
3.4.1 Laparoscopic Adjustable Gastric Banding
3.4.2 Laparoscopic Sleeve Gastrectomy
3.4.3 Laparoscopic Proximal Roux-en-Y Gastric Bypass
3.4.4 One-Anastomosis Laparoscopic Bypass
3.4.5 Biliopancreatic Diversion (According to Scopinaro)
3.4.6 Biliopancreatic Diversion with Duodenal Switch
3.5 Mechanisms of Action
3.5.1 Restriction and Malabsorption
Restriction
Malabsorption
3.5.2 Effects of Bariatric Surgery on the Regulation of Hunger and Satiety
Ghrelin
Nesfatin-1
Cholecystokinin
Pancreatic Polypeptide
Peptide YY
Glucagon-Like Peptide 1
Leptin
Insulin
Glucagon
Conclusion
3.5.3 Intestinal Flora (Microbiome)
Conclusion
3.5.4 Bile Acids
References
3.1–3.3
3.4.3
Further Readings
3.4.1
3.4.2
3.4.3
3.4.4
4: Metabolic Surgery
4.1 Prospective Studies
4.2 Meta-Analyses
4.3 Postoperative Incidence of Diabetes, Micro- and Macrovascular Complications, Life Expectancy
Conclusion
References
Further Readings
5: Preoperative Evaluation of the Patient
5.1 Surgical Evaluation
5.2 Internal Evaluation
5.3 Psychosomatic Evaluation
5.4 Choice of Procedure
5.5 Informing the Patient
References
5.1
5.2
5.3
Further Readings
5.2
5.3
5.4
5.5
6: Operation Preparation in Bariatric Surgery
6.1 Operating Room
6.2 Instruments
6.3 Positioning the Patient
6.4 Position of the Surgical Team
6.5 Antibiotic Treatment
6.6 Anticoagulation
6.7 Team Time Out
6.8 Structure of the Pneumoperitoneum
References
Further Readings
7: Anaesthesiology for Bariatric Surgery
7.1 Pathophysiological Aspects
7.1.1 The Cardiovascular System
7.1.2 Airway
7.1.3 Pulmonary System
7.1.4 Metabolism
7.1.5 Pharmacokinetics
Determination of Body Weight and Other Parameters
Pharmacokinetic Characteristics of Important Substances
7.2 Organisational Aspects
7.2.1 Personnel
7.2.2 Technical Equipment
Blood Pressure Measurement
Storage Material
Ultrasound
7.3 Pre-medication Rounds
7.3.1 Pre-medication Consultation
7.3.2 Comorbidities
Respiratory System
Cardiovascular System
7.4 Preparation of the Anaesthesia
7.4.1 Monitoring
7.4.2 Vascular Accesses
7.4.3 Selection of Anaesthetics
7.5 Induction and Maintenance of Anaesthesia
7.5.1 Preoxygenation
7.5.2 Anaesthetic Induction
7.5.3 Maintenance of Anaesthesia
7.6 Postoperative Phase
Further Readings
8: Laparoscopic, Adjustable Gastric Banding
8.1 Trocar Placement
8.2 Dissection
8.3 Placement of Gastric Band
8.4 Fixing the Gastric Band and Port
8.5 Aftercare, Band Filling
8.6 Pitfalls
Further Readings
9: Sleeve Gastrectomy
9.1 Trocar Placement
9.2 Exploration
9.3 Dissection
9.4 Gastric Tube Calibration
9.5 Resection
9.6 Test for Staple Line Insufficiency
9.7 Removal of the Resected Specimen
9.8 Finishing the Operation
9.9 Pitfalls
References
Further Readings
10: Laparoscopic, Proximal Roux-en-Y Gastric Bypass
10.1 Trocar Placement
10.2 Exploration
10.3 Creating the Gastric Pouch
10.4 Measurement of the Intestine
10.4.1 Dividing the Greater Omentum
10.4.2 Mobilizing the First Jejunum Loop
10.5 Gastrojejunal Anastomosis
10.5.1 Linear Stapled Anastomosis
10.5.2 Circular Stapled Anastomosis
Pressure Plate Inserted from the Abdomen
Pressure Plate Inserted Orally
10.5.3 Hand Sewn Anastomosis
10.6 Measuring the Alimentary Loop
10.7 Jejunojejunostomy
10.8 Dividing of the Biliopancreatic Loop
10.9 Testing the Gastro-entero Anastomosis for Leaks
10.10 Closing the Mesentery
10.11 Finishing the Operation
10.12 Pitfalls
Further Readings
11: Omega-Loop Bypass (One-Anastomosis Bypass, Mini-Gastric Bypass)
11.1 Indication
11.2 Trocar Placement
11.3 Dissection
11.4 Pouch
11.5 Measuring the Bypass Length
11.6 Anastomosis
11.7 Omega-Loop Bypass as a Redo Procedure After Sleeve Gastrectomy
11.8 Pitfalls
11.9 Peri- and Postoperative Management
11.10 Results
11.11 Complications and Complication Management
References
Further Readings
12: Biliopancreatic Diversion (Operation According to Scopinaro)
12.1 Introduction
12.2 Indication and Preparation for Surgery
12.3 Surgical Technique
12.3.1 Laparoscopy, Trocar Placement and Clarification of Operability
12.3.2 Transection of the Stomach
12.3.3 Measurement of the Loop Lengths
12.3.4 Small Intestine Anastomosis
12.3.5 Gastroileostomy
12.3.6 Simultaneous Appendectomy, Cholecystectomy and Hiatus Hernias
12.4 Pitfalls
12.5 Results
12.6 Morbidity and Mortality
References
Further Reading
13: Biliopancreatic Diversion with Duodenal Switch
13.1 Specific Indications for BPD-DS
13.2 Surgical Technique
13.2.1 Laparoscopy, Trocar Placement and Clarification of Operability
13.2.2 Sleeve Gastrectomy
13.2.3 Measurement of Loop Lengths
13.2.4 Small Intestine Anastomosis (In Case of Classical Reconstruction According to Roux-en-Y)
13.2.5 Duodenum Transection
13.2.6 Duodenoileostomy
13.2.7 Simultaneous Appendectomy and Cholecystectomy
13.3 Pitfalls
13.4 Results
13.5 Morbidity and Mortality
References
Further Readings
14: Postoperative Management of Bariatric Surgery Patients
14.1 Initial Diet Regimen After Bariatric Surgery
14.1.1 First Stage
14.1.2 Second Stage
14.1.3 Third Stage
14.2 Long-Term Nutrition After Bariatric Surgery
14.3 Supplementation
14.4 Surgical Aftercare
14.5 Internal Aftercare
14.5.1 Follow-Up in the Early Postoperative Phase
14.5.2 Aftercare During the Weight Loss Phase (‘Honeymoon Phase’)
14.5.3 Aftercare in the Phase of Weight Stagnation or Weight Regain
14.5.4 Recommended Aftercare Intervals
14.5.5 Recommended Laboratory Diagnostics
14.6 Psychosomatic Aftercare
14.7 Surgical Complications
14.7.1 Early Surgical Complications
Postoperative Leak
Postoperative Bleeding
Postoperative Obstruction
Early Complications After Gastric Band Implantation
Early Complications After a Sleeve Gastrectomy
Early Complications After Gastric Bypass
14.7.2 Late Surgical Complications
Late Complications After Gastric Band Implantation
Late Complications After Sleeve Gastrectomy
Late Complications After Gastric Bypass Surgery
14.8 Internal Complications
14.8.1 Hyperinsulinemic Hypoglycemic Syndrome After Gastric Bypass Surgery
14.8.2 Osteoporosis
14.8.3 Further Complications
References
14.1–14.3
14.7.1
Further Readings
14.4
14.5
14.6
14.7.1
14.7.2
14.8
15: Revision and Redo Operations After Bariatric Procedures
15.1 Background
15.2 Revision/Redo Procedure After Gastric Banding
15.2.1 Indication
15.2.2 Procedure
15.3 Revision/Redo Procedure After Sleeve Gastrectomy
15.3.1 Indication
15.3.2 Procedure
15.4 Revision/Redo Procedure After Gastric Bypass Surgery
15.4.1 Indication
15.4.2 Procedure
Further Readings
16: Special Patient Groups in Bariatric Surgery
16.1 Surgery at Older Age
16.2 Surgery in Childhood and Adolescence
16.3 High Risk Patients
References
Further Readings
17: Obesity Centre
17.1 Establishment and Certification of an Obesity Centre
17.2 Interdisciplinary Treatment Team: Obesity Board
17.3 Necessary Hospital Equipment
17.4 Multimodal Treatment Processes
17.5 Self-Help Groups and Internet Portals
17.6 Patient Presentations and Information Material
17.7 Treatment and Patient Pathways
Further Readings
18: Alternative Techniques and Methods in Obesity Therapy
18.1 Gastric Plication
18.2 POSE Procedure
18.3 Endobarrier®
18.4 Gastric Sleeve with Ileum Interposition
18.5 Securing Different Operation Procedures with a Band or a Ring
18.6 Gastric Stimulator
18.7 Gastric Balloon
18.8 AspireAssist™
References
Further Readings
Index
