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Viszeralchirurgie 2006; 41(2): 104-113
DOI: 10.1055/s-2006-921525
Originalarbeit

© Georg Thieme Verlag Stuttgart · New York

Früh- und Spätkomplikationen nach Magenbypassoperationen und duodenaler Switch-Operation

Early and Late Complications after Gastric Bypass and DuodenalswitchR. A. Weiner1 , W. K. Karcz1 , S. Weiner1
  • 1Chirurgische Klinik, Krankenhaus Sachsenhausen Frankfurt a. M.
Further Information

Publication History

Publication Date:
30 March 2006 (online)

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Zusammenfassung

Der Anstieg bariatrischer Eingriffe ist durch die höhere Akzeptanz dieser Verfahren exponentiell. Auch wenn sie eine relativ niedrige Komplikationsrate aufweisen, können sie zu folgeschweren Behinderungen und Folgen führen. Ungünstige Verläufe können auch ihre Ursache in einer unzureichenden Behandlung haben, die ein Problem für die Praxis der Adipositasbehandlung darstellen können. Aus diesen Gründen müssen Chirurgen, die solche Operationen ausführen, auf diesem Gebiet ein umfangreiches Wissen und technische Fähigkeiten besitzen, um auftretende Komplikationen zu beherrschen. Mangelzustände für Vitamine und andere Nährstöffe sind geläufig nach Magenbypass, biliopankreatischer Diversion ohne und mit Duodenalswitch. Sie können klinisch bedeutsam werden, wenn sie nicht erkannt und durch Supplementation behandelt werden. Zu diesem Zweck wird in diesem Artikel ein Überblick über die wichtigsten Komplikationen nach adipositaschirurgischen Eingriffen und Empfehlungen zu ihrer Behandlung gegeben.

Abstract

The rise in bariatric operations has been exponential because of the greater acceptance for these procedures. Although complication rates are relatively low, they can result in formidable disability. Adverse outcomes also result in medical malpractice claims that are particularly problematic for bariatric surgery practices. For these reasons, surgeons performing these operations must be knowledgeable and must possess the technical skills required for managing complications when they occur. Deficiencies in vitamins and other nutrients are common following the gastric bypass, biliopancreatic diversion with or without duodenal switch, and may become clinically significant if not recognized and treated with supplementation. The purpose of this article is to review the major complications that occur following anti-obesity procedures and to provide recommendations regarding their management.

Schlüsselwörter

morbide Adipositas - Magenbypass - Duodenalswitch - Komplikationen

Key words

morbid obesity - gastric bypass - duodenalswitch - complications

Literatur

  • 1 Buchwald H, Williams S E. Bariatric surgery worldwide 2003.  Obes Surg. 2004;  14 1157-1164
    CrossrefPubMedSearch in Google Scholar
  • 2 Santry H P, Gillen D L, Lauderdale D S. Trends in bariatric surgical procedures.  . 2005;  294 1909-1917
    CrossrefPubMedSearch in Google Scholar
  • 3 Schudziarra V, Hausmann M, Erdmann J. Adipositaschirurgie: Patientenselektion und Indikationsstellung.  Chirurg. 2005;  76 653-657
    CrossrefPubMedSearch in Google Scholar
  • 4 National Institute of health consensus Development Conference Statement . Gastrointestinal surgery for severe obesity: National Institutes of Health Consensus Development Conference statement.  Am J Clin Nutr. 1992;  55 615-619
    PubMedSearch in Google Scholar
  • 5 Sauerland S, Angrisani L, Belachew M, Chevallier J M, Favretti F, Finer N, Fingerhut A, Garcia Caballero M, Guisado Macias J A, Mittermair R, Morino M, Msika S, Rubino F, Tacchino R, Weiner R A, Neugebauer E A. Obesity surgery evidence-based guidelines of the European Association for Endoscopic Surgery (EAES).  Surg Endosc. 2005;  19 200-221
    CrossrefPubMedSearch in Google Scholar
  • 6 Mason E E, Ito C. Gastric bypass in obesity.  Surg Clin North Am. 1967;  47 1345-1351
    PubMedSearch in Google Scholar
  • 7 Cadiere G B, Himpens J, Dapri G. Laparoskopische Magenbypasschirurgie.  Chirurg. 2005;  76 668-677
    CrossrefPubMedSearch in Google Scholar
  • 8 Wittgrove A C, Clark G W, Tremblay L J. Laparoscopic gastric bypass, Roux-en-Y: preliminary report of five cases.  Obes Surg. 1994;  4 353-357
    CrossrefPubMedSearch in Google Scholar
  • 9 Buchwald H, Avidor Y, Braunwald E, Jensen M D, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis.  JAMA. 2004;  292 1724-1737
    CrossrefPubMedSearch in Google Scholar
  • 10 Scopinaro N, Adami G F, Marinari G M. et al . Biliopancreatic diversion.  World J Surg. 1998;  22 936-946
    CrossrefPubMedSearch in Google Scholar
  • 11 Hess D S, Hess D W. Biliopancreatic diversion with a duodenal switch.  Obes Surg. 1998;  8 267-282
    CrossrefPubMedSearch in Google Scholar
  • 12 Marceau P, Hould F S, Simard S. et al . Biliopancreatic diversion with duodenal switch.  World J Surg. 1998;  22 947-954
    CrossrefPubMedSearch in Google Scholar
  • 13 Gagner M, Ren C. Laparoscopic biliopancreatic diversion with duodenal switch for morbid obesity: early results.  Obes Surg. 2000;  10 333-334
    PubMedSearch in Google Scholar
  • 14 Gentileschi P, Kini S, Catarci M, Gagner M. Evidence-based medicine: open and laparoscopic bariatric surgery.  Surg Endosc. 2002;  16 736-744
    CrossrefPubMedSearch in Google Scholar
  • 15 Adami G F, Cordera R, Marinari G, Lamerini G, Andraghetti G, Scopinaro N. Plasma ghrelin concentration in the short-term following biliopancreatic diversion.  Obes Surg. 2003;  13 889-892
    CrossrefPubMedSearch in Google Scholar
  • 16 Roux C W, Aylwin S J, Batterham R L, Borg C M, Coyle F, Prasad V, Shurey S, Ghatei M A, Patel A G, Bloom S R. Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters.  Ann Surg. 2006;  24 108-114
    PubMedSearch in Google Scholar
  • 17 Marema R T, Perez M, Buffington C K. Comparison of the benefits and complications between laparoscopic and open Roux-en-Y gastric bypass surgeries.  Surg Endosc. 2005;  19 525-530
    CrossrefPubMedSearch in Google Scholar
  • 18 Nguyen N T, Rivers R, Wolfe B M. Early gastrointestinal hemorrhage after laparoscopic gastric bypass.  Obesity Surgery. 2003;  13 62-65
    CrossrefPubMedSearch in Google Scholar
  • 19 MacDonald K G. Magenbypass bei morbider Fettsucht.  Chirurg. 2000;  71 140-145
    CrossrefPubMedSearch in Google Scholar
  • 20 Brolin R E. Complications of surgery for morbid obesity.  Probl Gen Surg. 2000;  17 55-61
    PubMedSearch in Google Scholar
  • 21 Zingmond D S, McGory M L, Ko C Y. Hospitalization before and after gastric bypass surgery.  JAMA. 2005;  294 1918-1924
    CrossrefPubMedSearch in Google Scholar
  • 22 Ahmad J, Martin J, Ikramuddin S, Schauer P, Slivka A. Endoscopic balloon dilation of gastroenteric anastomotic stricture laparoscopic gastric bypass.  Endoscopy. 2003;  35 725-728
    Thieme ConnectPubMedSearch in Google Scholar
  • 23 Perugini R A, Mason R, Czerniach D R, Novitsky Y W, Baker S, Litwin D E, Kelly J J. Predictors of complication and suboptimal weight loss after laparoscopic Roux-en-Y gastric bypass: a series of 188 patients.  Arch Surg. 2003;  138 541-545
    CrossrefPubMedSearch in Google Scholar
  • 24 Nguyen N T, Stevens C M, Wolfe B M. Incidence and outcome of anastomotic stricture after laparoscopic gastric bypass.  J Gastrointest Surg. 2003;  7 997-1003
    CrossrefPubMedSearch in Google Scholar
  • 25 Go M R, Muscarella P, Needleman B J, Cook C H, Melvin W S. Endoscopic management of stomal stenosis after Roux-en-Y gastric bypass.  Surg Endosc. 2004;  18 56-59
    CrossrefPubMedSearch in Google Scholar
  • 26 Higa K D, Ho T, Boone K B. Laparoscopic Roux-en-Y gastric bypass: Technique and 3-year follow-up.  J Laparoendosc Adv Surg Tech A. 2001;  11 377-382
    CrossrefPubMedSearch in Google Scholar
  • 27 Barba C A, Butensky M S, Lorenzo M, Newman R. Endoscopic dilation of gastroesophageal anastomosis stricture after gastric bypass.  Surg Endosc. 2003;  17 416-420
    CrossrefPubMedSearch in Google Scholar
  • 28 Goitein D, Papasavas P K, Gagne D, Ahmad S, Caushaj P F. Gastrojejunal strictures following laparoscopic Roux-en-Y gastric bypass for morbid obesity.  Surg Endosc. 2005;  19 628-632
    CrossrefPubMedSearch in Google Scholar
  • 29 McLean G K, LeVeen R F. Shear stress in the performance of esophageal dilation: comparison of balloon dilation and bougienage.  Radiology. 1989;  172 983-986
    PubMedSearch in Google Scholar
  • 30 Sataloff D M, Lieber C P, Seinige U L. Strictures following gastric stapling for morbid obesity. Results of endoscopic dilatation.  Am Surg. 1990;  56 167-174
    PubMedSearch in Google Scholar
  • 31 Matthews B D, Sing R F, DeLegge M H, Ponsky J L, Heniford B T. Initial results with a stapled gastrojejunostomy for the laparoscopic isolated Roux-en-Y gastric bypass.  Am J Surg. 2000;  179 476-481
    CrossrefPubMedSearch in Google Scholar
  • 32 Papasavas P K, Caushaj P F, McCormick J T, Quinlin R F, Hayetian F D, Maurer J, Kelly J J, Gagne D J. Laparoscopic management of complications following laparoscopic Roux-en-Y gastric bypass for morbid obesity.  Surg Endosc. 2003;  17 610-614
    CrossrefPubMedSearch in Google Scholar
  • 33 Schauer P R, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity.  Ann Surg. 2000;  232 515-529
    CrossrefPubMedSearch in Google Scholar
  • 34 Schirmer B, Erenoglu C, Miller A. Flexible endoscopy in the management of patients undergoing Roux-en-Y gastric bypass.  Obes Surg. 2002;  12 634-638
    CrossrefPubMedSearch in Google Scholar
  • 35 Stahl R D, Sherer R A, Seevers C E, Johnston D. Comparison of 21 vs 25 mm gastrojejunostomy in the gastric bypass procedure - early results.  Obes Surg. 2000;  10 540-542
    CrossrefPubMedSearch in Google Scholar
  • 36 Higa K D, Boone K B, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1 040 patients - what have we learned?.  Obes Surg. 2000;  10 509-513
    CrossrefPubMedSearch in Google Scholar
  • 37 Higa K D, Ho T, Boone K B. Internal hernias after laparoscopic Roux-en-Y gastric bypass: incidence, treatment and prevention.  Obesity Surgery. 2003;  13 350-354
    CrossrefPubMedSearch in Google Scholar
  • 38 Champion J K, Williams M. Small bowel obstruction and internal hernias after laparoscopic Roux-en-Y gastric bypass.  Obesity Surgery. 2003;  13 596-600
    CrossrefPubMedSearch in Google Scholar
  • 39 Anthone G J, Lord R V, De Meester T R, Crookes P F. The duodenal switch operation for the treatment of morbid obesity.  Ann Surg. 2003;  238 618-627
    PubMedSearch in Google Scholar
  • 40 Rabkin R A, Rabkin J M, Metcalf B, Lazo M, Rossi M, Lehmanbecker L B. Laparoscopic technique for performing duodenal switch with gastric reduction.  Obes Surg. 2003;  13 263-268
    CrossrefPubMedSearch in Google Scholar
  • 41 Gagner M, Boza C. Laparoscopic duodenal switch for morbid obesity.  Expert Rev Med Devices. 2006;  3 105-112
    CrossrefPubMedSearch in Google Scholar
  • 42 McConnell D B, O'Rourke R W, Deveney C W. Common channel length predicts outcomes of biliopancreatic diversion alone and with the duodenal switch surgery.  Am J Surg. 2005;  189 536-540
    CrossrefPubMedSearch in Google Scholar
  • 43 Bloomberg R D, Fleishman A, Nalle J E, Herron D M, Kini S. Nutritional deficiencies following bariatric surgery: what have we learned?.  Obes Surg. 2005;  15 145-154
    CrossrefPubMedSearch in Google Scholar
  • 44 Keshishian A, Zahriya K, Willes E B. Duodenal switch has no detrimental effects on hepatic function and improves hepatic steatohepatitis after 6 months.  Obes Surg. 2005;  15 1418-1423
    CrossrefPubMedSearch in Google Scholar
  • 45 Sanchez-Hernandez J, Ybarra J, Gich I, De Leiva A, Rius X, Rodriguez-Espinosa J, Perez A. Effects of bariatric surgery on vitamin D status and secondary hyperparathyroidism: a prospective study.  Obes Surg. 2005;  15 1389-1395
    CrossrefPubMedSearch in Google Scholar
  • 46 Koffman B M, Greenfield L J, Ali I I, Pirzada N A. Neurologic complications after surgery for obesity.  Muscle Nerve. 2005;  32 945-950
    PubMedSearch in Google Scholar
  • 47 Buffington C, Walker B, Cowan G S, Scruggs D. Vitamin D deficiency in the morbidly obese.  Obes Surg. 1993;  3 421-424
    CrossrefPubMedSearch in Google Scholar
  • 48 Weiner R A, Blanco-Engert R, Weiner S. et al . Laparoscopic biliopancreatic diversion with duodenal switch: three different duodeno-ileal anastomotic techniques and initial experience.  Obes Surg. 2004;  14 334-340
    CrossrefPubMedSearch in Google Scholar
  • 49 Christou N V, Sampalis J S, Liberman M. et al . Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients.  Ann Surg. 2004;  240 416-423
    CrossrefPubMedSearch in Google Scholar
  • 50 Berger M. Perspektiven und Grenzen der Adipositasbehandlung.  Chirurg. 2000;  71 129-133
    CrossrefPubMedSearch in Google Scholar
  • 51 Pudel T, Ellrott T. Adipositas - ein gesellschaftliches Problem?.  Chirurg. 2005;  76 639-646
    CrossrefPubMedSearch in Google Scholar
  • 52 Brolin R E, Leung M. Survey of vitamin and mineral supplementation after gastric bypass and biliopancreatic diversion for morbid obesity.  Obes Surg. 1999;  9 150-154
    CrossrefPubMedSearch in Google Scholar
  • 53 Skroubis G, Sakellaropoulos G, Pouggouras K, Mead N, Nikiforidis G, Kalfarentzos F. Comparison of nutritional deficiencies after Roux-en-Y gastric bypass and after biliopancreatic diversion with Roux-en-Y gastric bypass.  Obes Surg. 2002;  12 551-558
    CrossrefPubMedSearch in Google Scholar

Prof. Dr. med. R. A. Weiner

Krankenhaus Sachsenhausen Frankfurt am Main · Chirurgische Klinik

Schulstr. 31

60594 Frankfurt/Main

Phone: 0 69/66 05 11 99

Email: rweiner@khs-ffm.de