Nutritive Defizite nach bariatrischer Chirurgie – systematische Literaturanalyse und Empfehlungen für Diagnostik und Substitution^[*]

Zusammenfassung

Die zunehmende Prävalenz der morbiden Adipositas geht auch in Deutschland mit einer deutlichen Zunahme von adipositas- und metabolisch-chirurgischen Eingriffen einher. Chirurgische und insbesondere metabolische Langzeitkomplikationen können Folge verschiedener restriktiver und malabsorptiver Operationsmethoden sein. Das Ziel der kompakten Kurzübersicht ist es, basierend auf einer selektiven Literaturrecherche und eigenen klinischen Erfahrungen die metabolischen Langzeitkomplikationen, die mit den verschiedenen bariatrischen Eingriffen assoziiert sind, darzustellen einschließlich der davon abzuleitenden Richtlinien einer Supplementation. Nach restriktiven OP-Verfahren wie dem Gastric Banding und der Sleeve-Gastrektomie sind Pouchdilatation und Bandmigration ebenso wie eine Refluxerkrankung schwerwiegende Langzeitkomplikationen. Nutritive Defizite nach restriktiven Verfahren betreffen meist die B-Vitamine. Malabsorptive Methoden wie die biliopankreatische Diversion, der Duodenal Switch und der Magenbypass sind mit Eisen-, Folsäure-, Vitamin-B₁-, Vitamin-B₁₂- und Vitamin-D-Defiziten assoziiert. Aufgrund der metabolischen und chirurgischen Komplikationen nach adipositaschirurgischen Eingriffen muss eine lebenslange Nachsorge der Patienten erfolgen. Die derzeitigen Leitlinien der Chirurgischen Arbeitsgemeinschaft Adipositastherapie (CAADIP) der DGAV zur Supplementation sollten dem klinisch tätigen Adipositas- und metabolischen Chirurgen hinsichtlich seiner obligatorischen Weiterbetreuungsverpflichtung nachhaltig bewusst sein.

Abstract

The increasing prevalence of morbid obesity in Germany is associated with an increasing number of metabolic surgical interventions. Short-term surgical and long-term metabolic complications such as nutrient deficiencies can be considered the main risks of metabolic surgery and its restrictive and malabsorbant surgical procedures. The aim of this compact short overview based on a selective literature search and our own clinical experience is to characterise the long-term metabolic complications, which are specific for the various bariatric procedures, and to refine the published guidelines for supplementation. Restrictive bariatric procedures can be associated with well-known surgical problems such as pouch dilatation or band migration, e.g., after gastric banding. After sleeve gastrectomy, emerging reflux disease can become a substantial problem. The most frequent deficiencies after restrictive procedures are related to B-vitamins whereas iron, folate, vitamin B₁ and B₁₂ and vitamin D deficiencies are associated with the malabsorptive procedure such as biliopancreatic diversion, duodenal switch and Roux-en-Y gastric bypass. Due to possible metabolic and surgical complications after bariatric surgery, patients need to undergo life-long medical follow-up investigations. The currently available guidelines of German Society of Treatment of Obesity (CAADIP) of DGAV for supplementation should be known and followed, in particular, by the physicians who i) are exceptionally involved in medical care of obese people and ii) do it in full awareness of the obligatory postoperative clinical observation.

Schlüsselwörter

Adipositaschirurgie - morbide Adipositas - metabolische Komplikationen - Supplementation - nutritive Defizite - Diagnostik - bariatrische Chirurgie

Key words

obesity surgery - morbid obesity - metabolic complications - supplementation - nutrient deficiencies - diagnostics - bariatric surgery

^* Prof. Dr. Dr. H. Lippert gewidmet

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