[Patient selection as the key to success of metabolic surgery].
BACKGROUND
The indications for bariatric interventions consist of the objectives to improve the quality of life and to prolong survival by remission of obesity-associated comorbidities. Until now the selection criteria for patients to undergo surgery which allow a prediction of therapeutic success are obscure.


OBJECTIVE
The aim of the study was to identify the prerequisites for selection of overweight and obese patients to undergo bariatric surgery.


RESULTS
Obesity per se is a proven indication for bariatric surgery due to the associated increase in mortality; however, not all obese patients can be considered for weight reduction surgery. A decisive factor for patient selection is the evidence of behavioral change regarding nutrition, composition and frequency of meals as well as increased ambulation. In patients with psychiatric diseases and behavioral disorders responsible for obesity a specific therapy is mandatory as well as intensive counseling and adherence to a lifelong follow-up.


CONCLUSIONS
It seems that therapeutic success on a long-term basis is only guaranteed by behavioral changes. Preoperative multimodal therapy does not influence the outcome but it seems possible that such treatment may contribute to increased adherence to the behavior necessary for therapeutic success. Nevertheless, such treatment must not constitute a barrier against bariatric surgery. However, patients who are not willing to change their pathological behavior do not qualify for weight-reducing surgery because otherwise therapeutic success is questioned.
Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W 1, 48149, Münster, Deutschland, m.colombo.benkmann@uni-muenster.de.
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Colombo-Benkmann
D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D005247:Feeding Behavior / Q000523:psychology; D006801:Humans; D008019:Life Style; D024821:Metabolic Syndrome / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000523:psychology; D010349:Patient Compliance / Q000523:psychology; D010353:Patient Education as Topic; D018579:Patient Selection; D011788:Quality of Life / Q000523:psychology; D015431:Weight Loss / Q000502:physiology*