Stomach reduction is an umbrella term for surgeries that can be performed in patients with obesity to reduce the volume of the stomach and thus stop excessive calorie intake. For overweight patients who meet the criteria for stomach reduction, the risk of surgery is low compared to the long-term effects of obesity.

Overview

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When is a person considered to suffer from obesity?

In Germany, about 62% of men and 43% of women currently suffer from overweight (= BMI >25), and obesity (= BMI >30) even affects 25% of all adults. The number of overweight people has increased considerably in recent years, mainly due to a lack of physical activity and an unhealthy, high-calorie diet.

The so-called BMI (= body mass index) is a value derived from height and weight (body weight [kg] / body height to square [m²]), which is used in medicine to classify weight. A healthy normal weight is a BMI between 20 and 25, a BMI above 30 is called obesity. Obesity is classified into three levels (BMI > 30 = level I, BMI > 35 = level II, BMI > 40 = level III).

Being overweight for many years often leads to accompanying illnesses such as high blood pressure, fat metabolism disorders (such as an elevated cholesterol level) with cardiovascular risks or diabetes mellitus with long-term consequences such as kidney, nerve, vessel and eye damage.

When is a stomach reduction performed?

Stomach reductions are only performed in patients with severe overweight (BMI > 35). In addition, a conservative (i.e. non-surgical) treatment according to defined quality criteria should have taken place for at least 24 months and organic and otherwise treatable causes of overweight (e.g. hypothyroidism and other hormonal diseases) must have been ruled out.

Methods for stomach reduction

The most common methods of stomach reduction are:

  • gastric sleeve surgery (sleeve gastrectomy)
  • gastric bypass surgery
  • gastric band

A large part of the stomach is removed during the gastric sleeve surgery. This is a purely restrictive procedure, i.e. it reduces the volume of the stomach.

In gastric bypass surgery, in addition to reducing the size of the stomach, the absorption distance (= the distance of the small intestine in which nutrients are absorbed) is shortened.

With the gastric band surgery a band is put around the stomach, which is connected with a hose with a chamber under the skin. This allows the gastric band to be filled with more or less liquid as needed, thus lowering or increasing the passage of the gastric juices from the small stomach through the band into the main stomach.

All three surgeries can be performed laparoscopically (keyhole technique), which causes significantly less post-surgery wound pain and allows faster mobilization and early discharge from the hospital.

Risks and chances of stomach reduction

Every stomach reduction is associated with a risk, albeit low. Perioperative risks or possible complications include wound healing disorders or cardiovascular problems such as thromboses. Possible late complications include adhesions or incisional fractures, but the risk of these late complications has been significantly reduced by the introduction of laparoscopic surgical techniques. Overall, in overweight patients who meet the criteria for surgery, the risk of surgery is low compared to the late effects of pathological obesity.

What kind of follow-up treatment does stomach reduction require?

After each of these stomach-reducing procedures, postoperative medical aftercare is necessary. For example, a vitamin substitution of vitamin B12 in the form of a three-month injection is always indicated for life after a gastric bypass surgery and often after a gastric sleeve surgery. The position of a gastric band should be regularly checked endoscopically (by gastroscopy).

A long-term weight reduction requires a consistent change in diet under medical supervision.

Conclusion on stomach reduction

The success of obesity surgery is different for each procedure, but has been proven by numerous clinical studies. As a rule, weight reduction also improves accompanying diseases such as high blood pressure, diabetes mellitus or fat metabolism disorders such as increased cholesterol levels.