Obesity and Metabolic Surgery

Description

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. 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