Adipositas-Chirurgie – eine sichere Option bei Risiko-Patienten mit irreversibler Organ-Dysfunktion

Zusammenfassung

Einleitung Adipositas-Chirurgie ist weltweit etabliert und sicher durchführbar. Mit steigender Expertise werden auch zunehmend Risikopatienten operiert, die z.B. bei Organdysfunktion zu adipös für eine geplante Organtransplantation sind.

Patienten und Methoden In dem Zeitraum 1/13 bis 6/9 wurden 653 Patienten an unserem Zentrum adipositaschirurgisch versorgt. Die Daten wurden retrospektiv ausgewertet und es fanden sich unter den 653 Patienten 34 Patienten mit dialysepflichtiger Niereninsuffizienz, hochgradiger Herzinsuffizienz (linksventrikuläre Ejektionsfraktion < 30 %) oder Leberzirrhose (Child-Pugh-Stadium A und B). Das Minimum-Follow-up beträgt 12 Monate.

Ergebnisse Bei 5 der 34 Patienten (14,7 %) kam es zu einem komplizierten Verlauf. Folgende Komplikationen traten auf: 3x Wundheilungsstörung mit konservativer Therapie, 1x subkutane Nachblutung bei einem Patienten mit LVAD (konservative Therapie) und 1 Shunt-Verschluss, der operativ revidiert wurde.

Schlussfolgerung Adipositaschirurgische Eingriffe sind auch bei Risikopatienten mit geringer Morbidität und Mortalität durchführbar.

Abstract

Introduction Bariatric surgery is recognized worldwide as an effective, safe ad feasible treatment. With increasing expertise also high-risk patients with irreversible organ-dysfunction are operated to enable for example organ-transplantation.

Patients and Methods 653 bariatric patients were analysed retrospectively over a period of 6 years. 34 patients could be identified as high risk-patients with renal insufficiency requiring dialysis, liver cirrhosis (Child-Pugh-classification A or B) or severe heart failure (left ventricular function <30%). The minimum follow-up period was one year.

Results Five patients (14,7%) had a complicated postoperative course: in 3 patients occurred wound healing disorders (conservative treatment), one patient with cardiac support system suffered from a subcutaneous bleeding (conservative treatment) and one patient with postoperative dialysis shunt closure had to be operationally revised.

Conclusion Bariatric surgery is safe and feasible also in high-risk patients with irreversible organ-dysfunction with low morbidity and mortality.

Schlüsselwörter

bariatrische Hochrisiko-Patienten - irreversible Organ-Dysfunktion - postoperative Morbidität

Key words

high-risk bariatric patients - irreversible organ-dysfunction - postoperative morbidity

^* Co-Erstautoren

Publication History

Article published online:
30 November 2020

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