title: Bariatric surgery.
abstract: BACKGROUND
  Bariatric surgery has increased in numbers, but the treatment of morbid obesity in Germany still needs improvement. The new interdisciplinary S3-guideline provides information on the appropriate indications, procedures, techniques, and follow-up care.
  
  
  METHODS
  Systematic review of the literature, classification of the evidence, graded recommendations, and interdisciplinary consensus-building.
  
  
  RESULTS
  Bariatric surgery is a component of the multimodal treatment of obesity, which consists of multidisciplinary evaluation and diagnosis, conservative and surgical treatments, and lifelong follow-up care. The current guideline extends the BMI-based spectrum of indications that was previously proposed (BMI greater than 40 kg/m(2), or greater than 35 kg/m(2)with secondary diseases) by eliminating age limits, as well as most of the contraindications. A prerequisite for surgery is that a structured, conservative weight-loss program has failed or is considered to be futile. Type 2 diabetes is now considered an independent indication under clinical study conditions for patients whose BMI is less than 35 kg/m(2) (metabolic surgery). The standard laparoscopic techniques are gastric banding, gastric bypass, sleeve gastrectomy, and biliopancreatic diversion. The choice of procedure is based on knowledge of the results, long-term effects, complications, and individual circumstances. Structured lifelong follow-up should be provided and should, in particular, prevent metabolic deficiencies.
  
  
  CONCLUSIONS
  The guideline contains recommendations based on the scientific evidence and on a consensus of experts from multiple disciplines about the indications for bariatric surgery, the choice of procedure, techniques, and follow-up care. It should be broadly implemented to improve patient care in this field.
authors.affiliation: Klinik für Allgemein-Visceral- und Kinderchirurgie, Schwarzwald-Baar Klinikum Villingen-Schwenningen. avc@sbk-vs.de
authors.forename: Norbert
authors.initials: N
authors.lastname: Runkel
authors.forename: Mario
authors.initials: M
authors.lastname: Colombo-Benkmann
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Hüttl
authors.forename: Harald
authors.initials: H
authors.lastname: Tigges
authors.forename: Oliver
authors.initials: O
authors.lastname: Mann
authors.forename: Stephan
authors.initials: S
authors.lastname: Sauerland
mesh_terms: D050110:Bariatric Surgery / Q000009:adverse effects* / Q000379:methods*; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000209:etiology*; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D008286:Malabsorption Syndromes / Q000000981:diagnostic imaging / Q000209:etiology*; D009767:Obesity, Morbid / Q000601:surgery*; D011859:Radiography