• Jodok Fink, Gabriel Seifert, Matthias Blüher, Stefan Fichtner-Feigl, and Goran Marjanovic.
• Department of General and Visceral Surgery, Center for Obesity and Metabolic Surgery, Medical Center, University of Freiburg; Helmholtz-Institute for Metabolic, Obesity and Vascular Research, (HI-MAG), Helmholtz Zentrum München at the University of Leipzig and the Medical Faculty of Leipzig AöR.
• Dtsch Arztebl Int. 2022 Feb 4; 119 (5): 708070-80.

BackgroundIn 2017, the prevalence of obesity (BMI ≥= 30 kg/m2) in Germany was approximately 16%. Obesity increases an individual's risk of developing type 2 diabetes (T2DM) and arterial hypertension; it also increases overall mortality. Consequently, effective treatment is a necessity. Approximately 20 000 bariatric operations are performed in Germany each year.MethodsThis review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane databases and on current German clinical practice guidelines.ResultsThe types of obesity surgery most commonly performed in Germany, Roux-en-Y gastric bypass and sleeve gastrectomy, lead to an excess weight loss of 27-69% ≥= 10 years after the procedure. In obese patients with T2DM, the diabetes remission rate ≥= 10 years after these procedures ranges from 25% to 62%. Adjusted regression analyses of data from large registries have shown that the incidence of malignancies is 33% lower in persons who have undergone obesity surgery compared to control subjects with obesity (unadjusted incidence 5.6 versus 9.0 cases per 1000 person-years). The operation can cause vitamin deficiency, surgical complications, gastroesophageal reflux, and dumping syndrome. Therefore, lifelong follow-up is necessary.ConclusionIn view of an increasing number of patients undergoing bariatric surgery, it will probably not be feasible in the future for lifelong follow-up to be provided exclusively in specialized centers.

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