In Germany about 55% of the population are overweight at the moment, that means they have a BMI over 25. In fact, about 13% of the people in Germany are pathologically overweight.
Stomach reduction is the reduction in size of the stomach with the aim that less food is consumed and pathological obesity (Obesity) is fought. There are various methods of surgically reducing the size of the stomach, which are usually only covered by health insurance companies under certain conditions. In Germany, however, a change in thinking can be observed. Excessive obesity is increasingly recognized as a chronic disease and is therefore accepted more and more frequently. At the moment there are around 2500 to 3000 operations per year that use various techniques to make the stomach smaller.
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Since a stomach reduction is an invasive procedure that can also lead to many complications, there are some requirements that must be met for surgery.
Only people between the ages of 18 and 65 are operated on.
If the stomach is downsized, there should be no addictions (such as drugs, tablets or alcohol), as this could lead to a shift in addiction. Since the food addiction is no longer possible due to the smaller stomach, some patients switch to other addictive substances. People who suffer from depression cannot have an operation either.
$config[ads_text2] not foundThe patient must be motivated to fully participate in the treatment, since an operation to reduce the size of the stomach is not enough. According to this, there are severe restrictions in everyday life, in particular the rules for the following diet. The patient must be informed about all risks.
The desired weight reduction can be achieved using various methods. In some, the stomach itself is made smaller (restrictive techniques) with other surgical techniques the stomach is bypassed in the digestive tract (bypass Techniques).
With the restrictive methods, the stomach is made smaller using a so-called gastric band or similar methods. Therefore, even after very small amounts of food, you will feel full and automatically eat less. Digestion is less affected by these methods because all parts of the stomach are still present. However, it can still happen that you don't keep your reduced weight so easily if you don't eat disciplined. Liquid or pulpy food can easily pass through the reduced stomach and is fully digested, so all calories are also absorbed. That would be particularly dangerous with ice cream, puddings and sodas of all kinds.
With the bypass methods, the stomach is bypassed directly, i.e. the esophagus is separated from the stomach and sewn directly back to the duodenum. With this method, the food is digested less strongly and thus fewer calories are absorbed, so the various bypasses belong to the malabsorptive (low or poor food intake) procedures.
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Below is an overview of all stomach reduction procedures:
A stomach reduction is a major surgical procedure that cannot be reversed. A distinction is made between gastric bypass and gastric tube surgery.
With a stomach tube resection, most of the stomach is removed so that only a small stomach tube remains. This procedure is technically less demanding than gastric bypass and the operation time is around an hour. Then there is the preparation time and the aftercare after the operation.
With gastric bypass, the food is channeled past the stomach via a short circuit with the small intestine. Depending on how complicated the operation is, the duration of the procedure is between two and five hours.
After gastric bypass, patients have to stay in the hospital for five to seven days. During this time, the patient recovers from the operation and slowly gets used to his smaller stomach and the associated change in diet.
In bariatric surgery (bariatric surgery) there are various methods to "shrink" the stomach and thus achieve weight loss. The costs are either borne by the health insurance company or borne by the patient himself.
Read more on the topic:
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A stomach reduction is a major surgical procedure that costs around 8,000 euros and more. In order for the statutory health insurance companies to cover the costs of the procedure, there are a number of requirements that must be met.
This first includes the patient's body weight. The BMI must be at least 40. For example, for a woman who is 175 cm tall, this means a weight of 123 kg. Such extreme obesity can usually no longer be brought under control by changing diet and exercise, and stomach-reducing surgery is the last resort. If there are other obesity-related concomitant diseases (e.g. diabetes mellitus or high blood pressure) in addition to being overweight, the health insurance will also pay for the procedure from a BMI of 35.
For a successful reimbursement of costs, a doctor must also certify that the patient has failed with all conventional methods of weight loss, such as regular exercise and a change in diet, over a period of six to twelve months. Furthermore, the patient must have attended a nutritional counseling service.
Read more on the subject at: Lose weight by changing your diet
In addition, there must be no severe addictions (drugs, alcohol), mental illnesses (e.g. depression) or severe metabolic diseases. Pregnant patients must also not be operated on. If these criteria are met, the health insurance company will cover the costs of stomach reduction for people between 18 and 65 years of age.
All stomach reduction procedures are invasive procedures that, like any other operation, involve numerous risks. Bleeding, bruising, and infection can occur. Pain and sensory disturbances in the operating area (due to the severing of fine nerves in the skin) can also occur.
Since these are very overweight patients who often suffer from comorbidities such as diabetes mellitus and high blood pressure, surgical interventions are generally more risky than in healthy patients and require special attention.
Even after the operation, complications such as wound healing disorders are more common in such patients. In addition, overweight patients have an increased risk of thrombosis or embolism.
Read more about this at: These are the risks of gastric bypass
Dumping syndrome is one of the side effects that can occur after stomach-reducing surgery. About 70 to 75% of all patients who undergo gastric surgery later suffer from dumping syndrome. The reduction in size of the stomach leads to an accelerated emptying of the stomach in the subsequent small intestine, which is called fall emptying.
A distinction is made between early and late dumping syndrome, depending on how quickly the symptoms appear after a meal.
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Food that is high in sugar or milk is particularly likely to cause voiding. The symptoms can be alleviated by changing the eating habits. In severe cases, drugs can also be used for therapy.
Most people who have been operated on stay in hospital for about 5 to 8 days for rehabilitation after surgery. Follow-up care begins now, i.e. the diet starts right away. It must also be checked whether the body accepts the operation well.
With a stomach reduction, the stomach is drastically reduced in size, so that only small amounts of food can be ingested. As a result, the patients are full faster and eat a lot less than before the operation. As a result, patients lose weight quickly. How much weight loss occurs after stomach reduction depends on the individual patient, his metabolism and his initial weight. A reduction in obesity by around two thirds in the first two years after the operation is quite realistic. Most patients lose about 16% of their body weight in a year. This relates to the fatty tissue, so only excess is broken down. In the following years there is then a further weight reduction.
In some cases even more is lost than the 16% mentioned above. Many operated on reported a weight loss of 40–60 kg in the first year. Many patients who weighed over 200 kg even reported a weight loss of 90 kg in the first year after the operation. All of this is especially true when following a strict diet and exercise plan.
Adhering to the strict diet is a prerequisite for weight loss and weight maintenance after surgery. But if everything is done, the prognosis for weight loss is very good.
A stomach reduction without a classic operation is only possible by inserting a gastric balloon. The gastric balloon is inserted endoscopically into the stomach via the esophagus. The procedure takes place under sedation on an outpatient basis. After inserting the balloon, it is filled with 500 to 700 ml of saline solution so that the stomach is already largely filled by the balloon.As a result, patients reach fullness more quickly when eating and the stomach is more or less “smaller”. The balloon is usually removed after 6 months.
However, the procedure brings with it some complications that should be considered. Many patients feel sick after inserting the gastric balloon. Abdominal pain can also last for several days.
It can also lead to dehydration (Dehydration) and a dangerous electrolyte shift. Since the saline solution in the balloon is coated with a dye (Methylene blue) is permeated, the urine turns blue if the balloon bursts. Then the balloon must be removed immediately. Other dangerous complications are death of the stomach wall (necrosis), Ruptures (Cracks) of the stomach and duodenum (duodenum) and intestinal obstruction (ileus).
Read more on the subject at: Gastric balloon
The prophylaxis of obesity includes a healthy diet and sufficient exercise, which is recommended at least three times a week, as well as reducing stress and lack of sleep. It is often forgotten that these factors can also lead to weight gain.