Skip to main content

Advertisement

SpringerLink
Log in

Evidence-based German guidelines for surgery for obesity

  • Review
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

The young field of obesity surgery (bariatric surgery) in Germany expands as a consequence of the rapid increase of overweight and obesity. New surgical methods, minimal access techniques, and the enormous increase of scientific studies and evidence, all contribute to the success of bariatric surgery, which is the only realistic chance of permanent weight loss and regression of secondary diseases in many cases.

Methods

A systematic literature review, classification of evidence, graded recommendations, and interdisciplinary consensus.

Results

Obesity surgery is an integral component of the multimodal treatment of obesity, which consists of multidisciplinary evaluation and preparation, conservative and surgical treatment elements, and a life-long follow-up. The guideline confirms the body mass index (BMI)-based spectrum of indications (BMI > 40 kg/m2 or >35 kg/m2 with secondary diseases) and extends it through elimination of all age restrictions (>18 years and <60 years) and most of the contraindications. Precondition for surgery is the failure of a structured conservative program of 6–12 months or the expected futility of it. Type II diabetes mellitus becomes an independent indication criterion for BMI < 35 kg/m2 (metabolic surgery). The standard techniques are gastric balloon, gastric banding, gastric bypass, gastric sleeve, and biliopancreatic diversion. The choice of procedure is based on profound knowledge of results, long-term effects, complications, and patient-specific circumstances. The after-care should be structured and organized long term.

Conclusion

The S3-guidelines contain evidence-based recommendations for the indication, selection of procedure, technique, and follow-up. Patient care should improve after implementation of these guidelines in clinical practice. Compliance by decision makers and health insurers is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fontaine KR, Redden DT, Wang C et al (2003) Years of life lost due to obesity. JAMA 289:187–193

    Article  PubMed  Google Scholar 

  2. Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292:1724–1737

    Article  PubMed  CAS  Google Scholar 

  3. Buchwald H, Estok R, Fahrbach K et al (2007) Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 142:621–632

    Article  PubMed  Google Scholar 

  4. Buchwald H, Estok R, Fahrbach K et al (2009) Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med 122:248–256

    Article  PubMed  Google Scholar 

  5. Sjöström L, Lindroos AK, Peltonen M et al (2004) Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 351:2683–2693

    Article  PubMed  Google Scholar 

  6. Sjöström L, Narbro K, Sjöström CD et al (2007) Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 357:741–752

    Article  PubMed  Google Scholar 

  7. Adams TD, Gress RE, Smith SC et al (2007) Long-term mortality after gastric bypass surgery. N Engl J Med 357:753–761

    Article  PubMed  CAS  Google Scholar 

  8. Sauerland S, Angrisani L, Belachew M et al (2005) Obesity surgery: evidence-based guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 19:200–221

    Article  PubMed  CAS  Google Scholar 

  9. Melissas J, Christodoulakis M, Schoretsanitis G et al (2001) Obesity-associated disorders before and after weight reduction by vertical banded gastroplasty in morbidly vs superobese individuals. Obes Surg 11:475–481

    Article  PubMed  CAS  Google Scholar 

  10. Catheline JM, Bihan H, Le Quang T et al (2008) Preoperative cardiac and pulmonary assessment in bariatric surgery. Obes Surg 18:271–277

    Article  PubMed  Google Scholar 

  11. Hallowell PT, Stellato TA, Schuster M et al (2007) Potentially life threatening sleep apnea is unrecognized without aggressive evaluation. Am J Surg 193:364–367

    Article  PubMed  Google Scholar 

  12. Heo M, Pietrobelli A, Fontaine KR, Sirey JA, Faith MS (2006) Depressive mood and obesity in US adults: comparison and moderation by sex, age, and race. Int J Obes 30:513–519

    Article  CAS  Google Scholar 

  13. Simon GE, Von Korff M, Saunders K et al (2006) Association between obesity and psychiatric disorders in the US adult population. Arch Gen Psychiatry 63:824–830

    Article  PubMed  Google Scholar 

  14. de Zwaan M, Wolf AM, Herpertz S (2007) Psychosomatische Aspekte der Adipositaschirurgie. Dtsch Ärztebl 104:2577–2583

    Google Scholar 

  15. Ashton D, Favretti F, Segato G (2008) Preoperative psychological testing—another form of prejustice. Obes Surg 18:1330–1337

    Article  PubMed  Google Scholar 

  16. Kim TH, Daud A, Ude AO et al (2006) Early U.S. outcomes of laparoscopic gastric bypass versus laparoscopic adjustable silicone gastric banding for morbid obesity. Surg Endosc 20:202–209

    Article  PubMed  CAS  Google Scholar 

  17. Marcus MD, Kalarchian MA, Courcoulas AP (2009) Psychiatric evaluation and follow-up of bariatric surgery patients. Am J Psychiatry 166:285–291

    Article  PubMed  Google Scholar 

  18. Colles SL, Dixon JB, Marks P et al (2006) Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr 84:304–311

    PubMed  CAS  Google Scholar 

  19. Alami RS, Morton JM, Schuster R, Lie J et al (2007) Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis 3:141–145

    Article  PubMed  Google Scholar 

  20. Dixon JB, O'Brien PE, Playfair J et al (2008) Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 299:316–323

    Article  PubMed  CAS  Google Scholar 

  21. Rubino F, Gagner M (2002) Potential of surgery for curing type 2 diabetes mellitus. Ann Surg 236:554–559

    Article  PubMed  Google Scholar 

  22. O'Brien PE, Dixon JB, Laurie C et al (2006) Treatment of mild to moderate obesity with laparoscopic adjustable gastric banding or an intensive medical program: a randomized trial. Ann Intern Med 144:625–633

    PubMed  Google Scholar 

  23. Shi X, Karmali S, Sharma AM, Birch DW (2010) A review of laparoscopic sleeve gastrectomy for morbid obesity. Obes Surg 20:1171–1177

    Article  PubMed  Google Scholar 

  24. Himpens J, Dapri G, Cadiere GB (2006) A prospective randomized study between laparoscopic gastric banding and laparoscopic isolated sleeve gastrectomy: results after 1 and 3 years. Obes Surg 16:1450–1456

    Article  PubMed  Google Scholar 

  25. Bohdjalian A, Langer FB, Shakeri-Leidenmühler S et al (2010) Sleeve gastrectomy as sole and definitive bariatric procedure: 5-year results for weight loss and ghrelin. Obes Surg 20:535–540

    Article  PubMed  Google Scholar 

  26. Himpens J, Dobbeleir J, Peeters G (2010) Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 252:319–324

    Article  PubMed  Google Scholar 

  27. Gould JC, Beverstein G, Reinhardt S, Garren MJ (2007) Impact of routine and long-term follow-up on weight loss after laparoscopic gastric bypass. Surg Obes Relat Dis 3:627–630

    Article  PubMed  Google Scholar 

  28. Harper J, Madan AK, Ternovits CA, Tichansky DS (2007) What happens to patients who do not follow-up after bariatric surgery? Am Surg 73:181–184

    PubMed  Google Scholar 

  29. Orth WS, Madan AK, Taddeucci RJ et al (2008) Support group meeting attendance is associated with better weight loss. Obes Surg 18:391–394

    Article  PubMed  Google Scholar 

  30. Song Z, Reinhardt K, Buzdon M, Liao P (2008) Association between support group attendance and weight loss after Roux-en-Y gastric bypass. Surg Obes Relat Dis 4:100–103

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Deutsche Gesellschaft für Allgemein- und Viseralchirurgie (DGAV), Klinik für Allgemein-, Visceral- und Kinderchirurgie, Vöhrenbacherstr. 15, 78050, Villingen-Schwenningen, Germany

    Norbert Runkel

  2. Deutsche Gesellschaft für Allgemein- und Viseralchirurgie (DGAV), Münster, Germany

    Mario Colombo-Benkmann

  3. Deutsche Gesellschaft für Allgemein- und Viseralchirurgie (DGAV), München, Germany

    Thomas P. Hüttl

  4. Deutsche Gesellschaft für Allgemein-und Viseralchirurgie (DGAV), Konstanz, Germany

    Harald Tigges

  5. Deutsche Gesellschaft für Allgemein- und Viseralchirurgie (DGAV), Hamburg, Germany

    Oliver Mann

  6. Deutsche Gesellschaft für Allgemein- und Viseralchirurgie (DGAV), Hannover, Germany

    Ricarda Flade-Kuthe & Ricarda Wunder

  7. Deutsche Gesellschaft für Allgemein- und Viseralchirurgie (DGAV), Mannheim, Germany

    Edvard Shang

  8. Deutsche Gesellschaft für Allgemein- und Viseralchirurgie (DGAV), Berlin, Germany

    Martin Susewind

  9. Deutsche Gesellschaft für Allgemein- und Viseralchirurgie (DGAV), Magdeburg, Germany

    Stefani Wolff

  10. Deutsche Adipositasgesellschaft (DAG), Bad Rothenfelde, Germany

    Alfred Wirth

  11. Deutsche Adipositasgesellschaft (DAG), Frankfurt, Germany

    Klaus Winckler

  12. Deutsche Gesellschaft für Ernährungsmedizin, Leipzig, Germany

    Arved Weimann

  13. Deutschen Gesellschaft für Psychosomatische Medizin und Ärztlichen Psychotherapie, Erlangen, Germany

    Martina de Zwaan

  14. Methodology, Köln, Germany

    Stefan Sauerland

Authors
  1. Norbert Runkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mario Colombo-Benkmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas P. Hüttl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harald Tigges
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Oliver Mann
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ricarda Flade-Kuthe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Edvard Shang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Martin Susewind
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Stefani Wolff
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ricarda Wunder
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Alfred Wirth
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Klaus Winckler
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Arved Weimann
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Martina de Zwaan
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Stefan Sauerland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Norbert Runkel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Runkel, N., Colombo-Benkmann, M., Hüttl, T.P. et al. Evidence-based German guidelines for surgery for obesity. Int J Colorectal Dis 26, 397–404 (2011). https://doi.org/10.1007/s00384-011-1136-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-011-1136-5

Keywords

Search

Navigation