Nachsorge und Supplementation nach Adipositaschirurgie

Zusammenfassung

Die Zahl der Patienten mit gewichtsreduzierenden Operationen wegen morbider Adipositas ist in den vergangenen Jahren sprunghaft angestiegen. Für restriktive Verfahren (Magenband, vertikale Gastroplastik, Sleeve-Gastrektomie) wird ein Excess weight loss (EWL) von 40 bis 55 Prozent beschrieben, wobei nachsorgepflichtige chirurgische Komplikationen eher selten sind. Eine Supplementation ist im Regelfall postoperativ nicht notwendig. Operationsverfahren mit malabsorptiver Komponente (Magen-Bypass, biliopankreatische Diversion mit/ohne Duodenalswitch) weisen einen stärkeren EWL von 50 bis 85 Prozent auf, sind jedoch mit einer höheren Komplikationsrate behaftet. Im Follow-up ist eine lebenslange Substitutionstherapie notwendig, da folgende Defizite häufig beobachtet werden: Protein bei 1,4 bis 3 Prozent der Patienten, Eisen bei 45 bis 52 Prozent, Folsäure bei 35 Prozent, Vitamin B₁₂ bei 33 bis 37 Prozent, Kalzium bei zehn bis zwölf Prozent, Vitamin D bei 45 Prozent und andere fettlösliche Vitamine (A, E, K) bei 10 bis 23 Prozent. Obwohl gleichzeitig nach Malabsorptions-Operationen eine verminderte Nahrungsaufnahme wichtiger Nährstoffe und Vitamine beobachtet wird, sind derzeit keine einheitlichen Empfehlungen zur notwendigen Substitution in der Literatur verfügbar. Zukünftige prospektive Studien sind notwendig, um die klinische Beurteilung dieser Mangelzustände besser einschätzen zu können.

Summary

The number of patients who undergo bariatric surgery for morbid obesity has increased dramatically over the past years. For restrictive methods (adjustable gastric banding, vertical gastroplasty, sleeve-gastrectomy) an Excess weight loss (EWL) of 40-55 % is described in which surgical complications are rather rare in the follow-up. A supplementation post-operatively is not necessary in the rule. Following operations with malabsorptive components (gastric bypass, biliopancreatic diversion with/without duodenal switch) some studies showa stronger EWL from 50-85 %. However,a higher complication rate is registrated. A lifelong substitution therapy is necessary in the follow-up since the most commonly nutritional deficiencies are frequently watched: protein 1.4–3 %, iron 45–52 %, folate 35 %, vitamin B₁₂ 33–37 %, calcium 10–12 %, vitamin D 45 % and other fat-soluble vitamins (A, E, K) 10–23 %. Although low nutrient levels are discovered following malabsorptive bariatric surgery, there is a lack of recommendations in the literature in the dosing and form of supplementation. Further prospective studies are required to evaluate the clinical significance of possible nutritional deficiencies.

Schlüsselwörter

Morbide Adipositas - Adipositaschirurgie - Supplementation - Ernährungsdefizit

Keywords

Morbid obesity - bariatric surgery - supplementation - nutritional deficiencies

• Literatur

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