The focus of the obesity center Frankfurt am Main at Krankenhaus Sachsenhausen is on bariatric surgery. In this area, the house is one of the leading clinics in Germany, with years of experience and over 500 interventions per year. The spectrum ranges from the gastric bypass, via the tube stomach and the gastric band, to biliopancreatic diversion, plastic reconstructive surgery and all revision procedures. But also the gastric balloon or the endobarrier intervention are carried out.
Accompanying the surgery is the so-called multimodal therapy concept, consisting of exercise, diet change, behavioral change and medically accompanied weight loss.
In addition to the minimally invasive surgical therapy, the Sachsenhausen hospital also offers the option of conservative therapy, in which the cause of obesity is deliberately eliminated by changing diet. The self-help group, which is also based in Frankfurt's Adiposity Center, helps sufferers from the very beginning to make the necessary applications to the health insurance companies, to providing moral support on their way to a healthier life.
High Level of Professionalism in Bariatric Surgery
At the Frankfurt Sachsenhausen Obesity Center, we offer a variety of therapeutic procedures. In addition to conservative therapeutic measures (kinesitherapy, diet therapy and behavioural psychotherapy), we also have a high level of competence in bariatric surgery. Worldwide studies have proven the effectiveness of these surgical interventions. At our clinic, we offer all popular surgical methods to treat obesity. These include:
- Sleeve gastroplasty
- Gastric Bypass (in several variants)
- Biliopancreatic shunting (Scopinaro Biliopancreatic shunting, Larrad single-anastomosis duodeno-ileal bypass with a longitudinal resection of the stomach (SADI-S))
- Gastric banding
It is often sensible to combine conservative and surgical methods to treat obesity. In this way you will be able not only to achieve the desired weight, but also to maintain it for a long time thanks to a comprehensive and effective rehabilitation program. This so-called multimodal programme will involve not only your family doctor, but also specialists in various fields of medicine.
You can find more information about the different types of treatment and surgical techniques for treating obesity on our website below.
The Obesity Center at Sachsenhausen Hospital treats people who are so overweight that their health is at risk. It threatens cardiovascular disease, diabetes, stroke and cancer. In particular, fat people suffer from social exclusion. To draw attention to the disease obesity, pilgrims eleven victims on 6 May on the Way of St. James in Spain. Reporter Stefanie Wehr spoke with the chief surgeon Plamen Plamen Staikov and the patient Conny Grunert (54).
Mrs. Grunert, Mr. Staikov, why is it so important to draw attention to obesity?
CONNY GRUNERT: Most people do not realize that they are ill. I did not know, even when I was 101 pounds and could not walk anymore because my discs did not cooperate.
PLAMEN STAIKOV: We want to raise awareness about overweight, which affects a very large part of the population. A quarter of adults in Germany are highly overweight. We also want to show that those affected are quite interested in doing something against overweight. It is simply an assumption and a prejudice that overweight people do not want to move, do not lead a normal life and do not want to be healthy.
So the hike should show the opposite?
GRUNERT: Right. It will be a huge challenge, we have a lot of respect for it. For me, it's my knee that worries me. Others are afraid that they do not have enough stamina. But we are looking forward to it. Television accompanies us, and we post our experiences on Facebook.
How is it that so many become severely overweight?
STAIKOV: In any case, it has nothing to do with the fact that those affected are too lazy. Obesity is based primarily on genetic predisposition. In addition, there is a permanent oversupply of calories in our Western world. People are moving less. Prevention in Germany has no effect, and the number of obese children is rising, and that's scary because many of them will later become seriously ill.
GRUNERT: For me it was predisposition and that I just thought: My mother is fat, my relatives are almost all fat, it's just like that. I did one diet after another, but with the yo-yo effect the kilos came back twice a short time later. Eventually, the body is messed up and the metabolism disturbed.
STAIKOV: Diets do not help, they hurt sooner, that's proven. The body wants to restore its original weight. Diets work only as long as you do them, and you can not hold them for life.
Are there effective strategies for overweight?
STAIKOV: On the one hand, more prevention must be provided so that understandable information is disseminated about how obesity develops. And on the other hand, those affected must be treated specifically. The disease obesity is only managed in Germany. It usually lacks the clear recommendation of the family doctor to start early treatment. The sooner the person begins to be treated, the better.
What does a treatment look like?
STAIKOV: Most people who are overweight need support in the form of competent medical support. Because the only thing that helps is a permanent change of diet and more exercise in everyday life. The third pillar is behavioral therapy at the psychologist. It is made clear to the patient in which form he does not eat properly. Some eat too much, can not stop, because the saturation does not set. Some eat at night, some too often. These are all eating disorders that can be treated.
Until you get through to it all, something has to happen, you have to be made to do something.
STAIKOV: Yes, the GPs are still doing too little, but they often can not recommend anything, because there are simply too few offers for comprehensive support, especially in the countryside. Very rarely, they recommend surgical treatment, which is often needed.
GRUNERT: For me, my back surgeon, who operated on my spine, got me on my way to obesity treatment. My health insurance then sent me to rehab. There were cooking classes, exercise program, talks with the psychologist. At 101 kilos I came to the hospital and got a gastric bypass surgery.
When will such an operation be necessary?
STAIKOV: There are guidelines for treatment, ie recommendations. In Germany, we begin the operative treatment far too late. With a BMI (Body Mass Index) of 50 you can operate directly after the recommendation. From a medical point of view, however, starting with a BMI of 40, sometimes 35, it makes sense and is necessary to study the subject of surgery.
The health insurance companies are obviously not of the opinion that one should intervene operationally?
STAIKOV: Many health insurances are very restrictive, the patients are the victims.
What exactly is done during the operation?
STAIKOV: In the case of perineum surgery, the stomach is reduced and the stomach volume is reduced by 75-80 percent. This will cause you to get full sooner and thus eat less calories. The second method is gastric bypass. The stomach is brought to a volume of 20 to 30 milliliters, about the size of an espresso cup. The small intestine is shortened and sutured to the stomach. As a result, the actual digestion takes place in the intestine and is thereby changed.
What has improved for you since the operation, Ms. Grunert?
GRUNERT: After the operation, a new life has started for me. I've lost 41 pounds since then and eat less and much healthier. I also do not take painkillers for my back and no other medicines. I go out a lot with friends, do a lot, which makes me very good. But the way there took years and was bad. I lost my job, was berentet. I did not want to live for a while. It was also bad that it took so long until the health insurance had a look and granted me the operation.
GRUNERT: Now comes the post-treatment, in which the excess skin must be removed. Because it is very uncomfortable, you sweat under the wrinkles, has constantly inflammation, and they do not look beautiful. And I go regularly to the support group, which has supported me a lot on my way.
STAIKOV: The treatment is not completed with the operation. Obesity is not curable. It is all the more important that something be done early.
When stomach surgery is performed to treat severe obesity, in some cases this may not be the end of obesity therapy. If dieting does not help with heavy obesity, the last hope is a surgical procedure that reduces food intake and utilization in the body. However, in some cases surgery may not be enough to help those affected gain normal weight.
"Often follow-up interventions are necessary," explains Prof. MD Plamen Staikov, obesity specialist and medical director at the obesity center in the Sachsenhausen hospital in Frankfurt. "Especially in Germany patients come very late to a first intervention. If a patient already has a Body Mass Index (BMI) of 55-60, we need to tell him before the first surgery that a second surgery may be needed to help him on his way to normal weight." After all, an operation is not a guarantee certificate, but just a building block of many, according to the expert. A change in diet and adequate exercise lifelong became an issue for obesity patients. In addition, as part of the follow-up regular examinations and weight controls. It is not uncommon for people with weight problems to fall back into old patterns after initial discipline and regain weight despite surgery. Even if nutritional measures can not be remedied here, the patient must again be surgically prevented from contracting.
How difficult is a new obesity operation?
"In any case, these are complex interventions that are routinely offered only at selected centers in Germany and neighboring countries," emphasizes Prof. MD Plamen Staikov. "Artificially limiting our food intake requires the highest precision". For the patients themselves, neither a first nor a second intervention are particularly stressful because they are performed minimally invasively in the so-called "keyhole technique". However, caution should be exercised if patients also suffer from other chronic diseases. Prof. MD Plamen Staikov advises those affected to have a revision performed by a doctor who is experienced in this area.
Do not neglect aftercare
The blame for the many revision interventions, among other things, is the bad aftercare situation. The aftercare is not always as good as it should be because of budgeting, the obesity specialist Prof. MD Plamen Staikov: "It would be best to continue to care for obese patients throughout their lives after a successful operation. This includes regular weight checks as well as a check of the blood values in order to be able to compensate for possible deficiencies immediately. In particular, in surgical techniques that reduce nutrient uptake, e.g. in the case of bilioprankreatic diversion, pronounced iron and protein deficiencies can arise". Also vitamins and other minerals would often have to be taken in the form of dietary supplements. In Germany, only 20 percent of patients come to follow-up care two years after surgery. In Switzerland, from Prof. MD Plamen Staikov's point of view has established a near-perfect aftercare system, it is still more than 85 percent after five years.
Do not wait too long if you are overweight
Prof. MD Plamen Staikov often wishes that his patients had come to him ten years earlier. This could prevent many irreversible sequelae, the specialist believes: "The best would be an official treatment recommendation from a BMI of 30. So we could help earlier and end the unhealthy weight spiral".
After ten years of the German register "Bariatric Surgery", the data of more than 45,000 patients are available. The choice of procedure is always an individual decision, there is no gold standard.
Although Germany occupies a top position in the incidence of obesity and type 2 diabetes, the number of bariatric interventions in relation to the population is significantly lower than in neighboring countries. The frequency of operations in the presence of morbid obesity is currently 10.5 per 100,000 adults. In other European countries it is many times higher (Sweden: 114.8; France: 86.0; Switzerland: 51.9). Although the number of interventions has increased significantly in Germany over the past decade and bariatric-metabolic surgery has become a recognized specialty in visceral surgery, access to surgery with considerable regional differences is made more difficult for patients due to the individual decision of the health insurance companies.
There is no gold standard for bariatric interventions. A choice of procedure based on objective parameters is therefore unthinkable. The choice of surgical procedure is always an individual decision. The "German Bariatric Surgery Registry" (GBSR) has allowed a retrospective analysis of the care situation in obesity surgery since 2005. This prospective observational study, also referred to as the "quality assurance study for surgical therapy of obesity", provides extensive information on diagnostics, operative therapy, postoperative course and long-term course Metabolic surgery was available from 45 121 patients.
Primary, redo interventions and revisions are recorded
The GBSR aims to analyze the current situation of obesity and metabolic surgery in Germany. For this purpose, primary operations as well as surgical revisions are recorded, as well as re-do operations to convert one surgical procedure into another - for example, changing a gastric tube into a gastric bypass. Early and late complications are analyzed depending on the surgical method, body mass index (BMI), comorbidities and other accompanying variables. The long-term goal parameters are the analysis of the extent of weight loss and the influence of comorbidities.
The GBSR was supported by the BMBF from 2012 to 2015 and is the only operative therapy study in the competence network obesity. Since January 1, 2005, perioperative and late results of bariatric surgery at the Institute for Quality Assurance in Operative Medicine gGmbH of Otto von Guericke University Magdeburg have been recorded in a risk-adjusted manner. 169 clinics take part, around 92% of all obesity and metabolic surgical interventions in Germany were recorded in this way.
The average age of the patients was 42.7 years, with 71.5% (n = 28 395) significantly more women than men (28.5%; n = 11 316) underwent such an intervention. Obesity-associated comorbidities increased steadily during the observation period; at the time of surgery, 90.26% of men and 85.05% of women suffered from at least one comorbidity. With 50.67 kg / m2, men had a significantly higher BMI than women with 48.69 kg / m2.
Restrictive and malabsorptive procedures: Common restrictive interventions include gastric banding (GB) and sleevegastrectomy (SG) or gastric sleeve. While the gastric band constricts the diameter in the upper part of the stomach, the stomach of the tube is created by a left-lateral gastric resection. This not only makes the stomach smaller, it also switches off hormone-producing components that influence the feeling of satiety.
The Roux-Y gastric bypass (LRYGB) is a more complex intervention, it is not only restrictive, but also has a targeted malabsorptive effect. There remains a small stomach pouch that is directly connected to the jejunum, the passage through the duodenum and large portions of the jejunum are switched off. Other malabsorptive procedures such as the bileopancreatic diversion (BPD), in which only around 100 cm of passage remain in the small intestine, and the BPD with duodenal switch (DS) hardly play a quantitative role in Germany.
Choice of procedure: After gastric bypass with 17 215 operations, sleevegastrectomy with 15 795 documented procedures is the second most common procedure. It also shows the largest increase in percentage terms over the entire period. Complex malabsorptive procedures currently play a subordinate role in Germany. The gastric band has been implanted in 4,124 cases since 2005, making it third.
A significant decrease in gastric band implantations was noted throughout the study. Patients with GB were significantly younger at 40.5 years than patients with all other procedures. They also had a significantly lower BMI of 44.92 kg / m2.
Patients who underwent SG had a significantly higher BMI and incidence of comorbidities compared to all other procedures. In particular, the frequency of concomitant diseases, diabetes and sleep apnea.
RYGB gastric bypass has been performed on 17,215 patients since 2005. There was a clear preference for laparoscopic access, over which 98.6% of the procedures were performed. Patients with RYGB (47.92 kg / m2) had a significantly lower BMI than patients with other procedures (50.27 kg / m2).
The more complex BPD (n = 148) was carried out in 17 institutions that participated in the study. Patients are older (43.4 vs. 42.7 years) and have a higher BMI (52.79 vs. 49.24 kg / m2) than patients with other procedures. The DS was performed in 16 participating facilities as a one-time operation in 168 cases. Patients with a duodenal switch are on average the oldest patients (46.7 versus 42.7 years) compared to other surgical procedures.
In the period from 2005 to 2014, 3,371 redo and 2,039 redo operations were carried out. The percentage distribution of revision interventions among the surgical procedures was shown in the table. Most common were revisions after primary GB (44.7%) due to late complications such as slipping, ligament defects or esophageal motility disorders.