[Increased requirements for the challenging abdominosurgical management of morbid obesity - what does the abdominal surgeon need to know?].
In the international comparison and in Europe, the Federal Republic of Germany belongs to the countries with a very high prevalence of obesity (men, 67.1 %; women, 53 %). Among the European countries, the incidence of diabetes mellitus type 2 is also high ("Study of the health of adults in Germany" [DEGS]) - Robert Koch Institute). Not only for surgeons, this can be considered as a great challenge even in usual abdominosurgical interventions. 1. Surgical equipment needs to be adapted to the requirements for obese patients. 2. Minimally invasive surgery reduces not only complication rates with regard to postsurgical wound infection and hernia in such patients, it allows a competent assessment of the peritoneal cavity. 3. A great number of surgical tools and instruments can be used in normal weight as well as morbidly obese patients with no limitations - for conventional (open) surgical interventions, retractor systems should be available. 4. With regard to emergency surgery in patients who had formerly undergone bariatric surgery, a competent basic knowledge on the usual bariatric surgical interventions and the subsequent anatomic consequences as well as the more frequent mid- and long-term complications is necessary, which need to be partially approached with the surgical intervention. 5. For numerous oncosurgical interventions, no differences in postoperative outcome were found between normal weight and morbidly obese patients.
Klinik für Allgemein-, Viszeral- und Kinderchirurgie, SRH Wald-Klinikum Gera gGmbH, Deutschland. christine.stroh@wkg.srh.de
C
C
Stroh
F
F
Meyer
T
T
Manger
D000005:Abdomen / Q000601:surgery*; D000006:Abdomen, Acute / Q000601:surgery; D050110:Bariatric Surgery; D003431:Cross-Cultural Comparison; D004630:Emergencies; D005260:Female; D005858:Germany; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009767:Obesity, Morbid / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D056888:Patient Positioning / Q000379:methods; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D012086:Reoperation; D013523:Surgical Equipment; D013525:Surgical Instruments; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome