Bariatric surgery and obesity treatment in Germany

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Bariatric surgery is a technically challenging surgical approach that demands comprehensive knowledge of abdominal surgery, proficiency in laparoscopic techniques, and an understanding of obesity causes and mechanisms. Technical equipment of the healthcare institution and collaborative work of specialists` team is important, as well. All these measures provide effective weight loss with prolonged and stable results.

Content

1. Obesity treatment programs
2. Is obesity an aesthetic or health problem?
3. When should I consider bariatric surgery?
4. Which type of bariatric surgery is the best exactly for me?
5. What will my life after the surgery be like?
6. Hospitals and treatment costs
7. How can I undergo treatment for obesity abroad?

Booking Health offers the following obesity treatment programs:

• Diagnostics of obesity
• Gastric banding
• Duodenal switch
• Gastric bypass
• Gastric sleeve surgery
• Gastric balloon placement
• Primary obesity surgery endoluminal (POSE) procedure
• Liposuction
• Laser liposuction

Is obesity an aesthetic or health problem?

In modern society, the image of a successful person is tightly connected with physical health and impressive appearance. A slender and harmonious figure makes both men and women feel more attractive and self-confident. At the same time, the problem of excessive body mass has drawn the close attention of the World Health Organization during the last 30-40 years.

According to the results of a number of clinical trials, excessive body mass or obesity is linked with certain health problems, namely:

• Higher risk of cardiovascular diseases, particularly this concerning myocardial infarction and stroke
• Extremely high risk of developing diabetes mellitus type 2 and all severe complications of the disease
• Pathology of the musculoskeletal system, particularly this concerns degenerative joint diseases
• Oncological disorders, namely, breast cancer, prostate cancer, cancer of the liver and colon
• Deterioration of general well-being – fatigue, memory impairment, lower intellectual activity

In the global scope, the number of people with obesity has almost doubled during the last 40 years. According to the up-to-date World Health Organization data, more than 50% of people in the European region have excessive body mass, and more than 20% are diagnosed with obesity.

The main causes underlying this threatening situation are the following:

• Giving preference to high-energy foods – sweets, bakery, and “snacks.” These products tempt people with attractive tastes and the possibility of having a bite during the working day.
• Lower physical activity due to widespread work at the computer, using public transport rather than walking or riding a bicycle, and avoiding active rest options.
• Presence of concomitant diseases and metabolic disorders, like disorders of the thyroid gland and adrenal glands, constant intake of certain drugs for the treatment of autoimmune diseases, and chronic problems with the cardiovascular system.

The high prevalence rate of obesity in the world`s scope, including obesity in children and adolescents, promotes thorough scientific research of this problem and the development of the most favorable solutions.

In particular, bariatric surgery, or “obesity surgery,” is the most effective treatment technique for patients with morbid obesity, especially with zero results in all other treatment options administration.

When should I consider bariatric surgery?

First of all, we should clearly understand the difference between bariatric surgery and usual plastic surgery, which is pointed at removing excessive adipose tissue. Plastic surgery influences only the external aspect of the problem and doesn`t affect its causes. Unfortunately, excessive body mass often returns after performing liposuction or abdominoplasty (techniques of the immediate body correction), bringing to naught the effectiveness of the intervention.

Bariatric surgery modifies the main pathological mechanism of obesity – redundant intake of nutrients, especially high-energy ones. In this case, body mass reduction is more natural and smooth, doesn`t cause any health problems, and remains stable over time.

Indications for bariatric intervention performing include the following:

• Body mass index (BMI, it determines the ratio of weight to height) over 40 kg/m²
• BMI from 35 to 40 kg/m² in the presence of the complications of obesity – persistent arterial hypertension, diabetes mellitus type 2, osteoarthritis and other pathology of joints, ischemic heart disease or myocardial infarction, sleep apnea
• BMI from 30 to 35 kg/m² in the presence of decompensated diabetes mellitus type 2 with multiple complications
• Presence of excessive weight during five years and more in combination with the absence of significant beneficial results from conservative treatment during six months and more
• Willingness of the patient to fulfill all the recommendations of the treating physician and maintain a healthy lifestyle in the future

The surgeon chooses the most appropriate kind of bariatric intervention for each patient in terms of the individual clinical situation – body mass, age and gender, and presence of concomitant disorders.

There are several basic types of bariatric interventions depending on surgical technique and principle of further body mass lowering:

• Restrictive method. Surgical interventions from this group substantially decrease the volume of the stomach, and thus the volume of food one can eat per meal. In addition, a feeling of satiety arises earlier after the meal and lasts longer. Surgeries from this group include sleeve gastrectomy or sleeve resection, intragastric balloon technique, and gastric banding.
• Malabsorptive method reduces the uptake of food without changes in the diet. The main mechanisms of such changes include deterioration of food digestion and lower absorption of digested food. Biliopancreatic diversion is an example of intervention from this group.
• Complex surgical techniques possess benefits of both methods – a lower volume of food and less intensive intestinal absorption of nutrients. Gastric bypass is the most effective complex surgical technique.

Bariatric surgeons should have practical experience in performing all types of operations, including laparoscopic ones. The technical equipment of the healthcare institution is of the same importance. This allows performing the most beneficial intervention for the patient without any technical or professional restrictions.

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Which type of bariatric surgery is the best exactly for me?

In each case type of the surgery is chosen individually, based on the results of obligatory preoperative examination:

• Physical examination, blood pressure measurement
• Electrocardiogram
• Spirogram
• Advanced laboratory testing
• Consultation of the surgeon
• Consultation of the anesthesiologist
• Gastroscopy

Doctors investigate the results of laboratory and instrumental examinations carefully and discuss possible personal treatment options with the patient. The patient's preferences are always considered when choosing a surgical technique.

The most effective types of bariatric surgeries are listed below:

• Intragastric balloon technique is one of the least invasive techniques that does not require surgical intervention and is performed during simple gastroscopy. This operation is suitable for patients with a slight increase in body mass (BMI from 28 to 35 kg/m²) and for patients who intend to lose 15-20 kg prior to further, more extensive bariatric intervention. During the procedure, a liquid-filled balloon is placed in the patient's stomach. The balloon occupies a certain volume of the stomach and thus limits the amount of food, contributing to a faster saturation. The balloon fulfills its function in the stomach for up to 6 months. After this, it is removed during repeated gastroscopy or under general anesthesia during the planned more extensive bariatric intervention.
• Gastric banding involves laparoscopic placement on the stomach of a special cuff (bandage) made of silicone. In this case, the cuff divides the stomach into two parts, reducing its volume. The size of the opening between the parts of the stomach is regulated by a special device placed under the skin so that the patient can control the amount of food and the rate of weight loss on his own. On the one hand, gastric banding is a minimally invasive intervention that preserves the natural movement of food through all parts of the gastrointestinal tract. On the other hand, gastric banding is connected with a high risk of complications – displacement of the cuff, functional disorders of the stomach, and inflammatory processes.
• Sleeve gastrectomy or sleeve gastric resection is a restrictive technique that involves removing almost all bodies of the stomach and formation of a smaller stomach in the form of a sleeve. During the operation, the part of the stomach that produces the hormones responsible for feeling hunger and saturation is removed. Thus, sleeve gastric resection has two mechanisms of body weight decrease – reducing the size of the stomach and reducing the feeling of hunger. Unlike previous techniques, resection of the stomach is irreversible, and its effect persists lifelong.
• Biliopancreatic diversion is a more extensive complex surgery that involves removing part of the stomach and special reconstruction of the small intestine to reduce fat absorption. This type of bypass is extremely effective in type 2 diabetes mellitus and high blood cholesterol levels. The body weight decrease after the operation is significant and, which is even more important, long-term. It should be noted that the result of the surgery doesn`t depend on the patient`s diet, as after the reconstruction of the small intestine, absorption of edible fats substantially decreases.
• Gastric bypass implies anatomical reconstruction of the stomach and small intestine, as well. During this surgery, part of the stomach, rich in digestive enzymes, and initial parts of the small intestine are cut off from the process of food digestion. A surgeon creates a new path for dietary masses movement, so they come from the upper part of the stomach immediately into the middle part of the small intestine. This is called “bypass.” Bypass is similar to biliopancreatic diversion by the mechanism of weight loss – after this type of surgery, the size of the working stomach decreases, and the activity of digestion and absorption of nutrients in the small intestine lowers, as well.
• Revision weight loss surgeries after previous bariatric interventions. Such procedures are considered to be more complicated, as the surgeon needs to reveal the complication of the previous intervention (often performed by another doctor) and correct it as effectively as possible. Plastic surgeries are also possible, such as abdominoplasty, correction of hips and shoulders shape, and mammoplasty. No more than 25% of patients require plastic surgery interventions; it is usually associated with insufficient elastic properties of the skin and the formation of excess skin folds.

What will my life after the surgery be like?

Up to 3 days after the surgery, the patient stays in the clinic under the supervision of qualified specialists. During the first 24 hours after the intervention state of the patient is monitored the most thoroughly – the patient stays in the special Intermediate Care unit, which is located near the intensive care unit and operating room. The next day the patient is transferred to a normal ward. At the same time, training begins – the patient receives information about important aspects of future life and special recommendations for the early postoperative period.

Recommendations for the period of adaptation during the first weeks after the bariatric surgery include the following:

• Having meal each 4-6 hours, which is approximately 4-5 meals a day
• Chewing food thoroughly and taking food slowly, paying attention to the feeling of satiety
• Separate taking food and drinks, the gap between them should be at least 30 minutes
• Intake of a sufficient quantity of liquid (non-carbonated drinks without sugar and alcohol) – 1,5-2,0 liters a day
• Giving preference to whole-grain products, vegetables, and fruits; having a sufficient amount of protein in the diet
• Keeping a food diary in written or electronic form
• Satisfactory level of physical activity – not less than 30 minutes of fast walking a day, swimming, aerobic sports

The scheme of long-term follow-up significantly depends on the chosen bariatric intervention but always includes the following aspects:

• Consultation on healthy nutrition, elaboration of an individual diet with a nutritionist, training in independent making menu for the day and week
• Development of an individual physical activity plan depending on the general condition of the patient and the desired rate of weight loss
• Consultation of the therapist and laboratory control in three months, six months, and a year after surgery; after this routine check-up is performed once a year in the absence of complaints
• Consultation of the endocrinologist and medicinal treatment of diabetes mellitus, if necessary.
• Working with a psychologist and attending self-help groups meetings – this motivates the patient to reach his goal and supports him along the way.

Pictorial and motivation for further work are ways of keeping a photo diary with comments on the process of reducing body weight, achievements, and plans for the future. Some patients make such diaries available on the Internet so that many people with similar problems can follow them and get inspired.

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Hospitals and treatment costs

The leading German hospitals that specialize in the treatment of obesity are:

1. Hospital St. Elisabeth Grevenbroich, Department of General, Abdominal, Vascular Surgery and Traumatology
2. HELIOS Clinic Krefeld, Department of General, Abdominal and Minimally Invasive Surgery
3. Academic Municipal Hospital Karlsruhe, Department of General and Abdominal Surgery
4. Academic Hospital Eichsfeld Heilbad Heiligenstadt, Department of General, Abdominal and Vascular Surgery
5. Hospital Nordwest Frankfurt-am-Main, Department of Obesity and Bariatric Surgery

The average cost of the main types of treatment is:

• Gastric band – €20,070
• Sleeve gastrectomy – €19,750
• Intragastric balloon placement – €7,290
• Biliopancreatic diversion – €19,875
• Laparoscopic or open gastric bypass surgery – €21,220
• Primary obesity surgery endoluminal (POSE) – €12,740
• Laser liposuction for obesity – €12,420
• Removal of excess adipose tissue by subcutaneous liposuction – €12,290

How can I undergo treatment for obesity abroad?

High standards of work and excellent qualifications of the German specialists make it possible to provide medical help to international patients, as well. As a rule, the Department of Bariatric Surgery leaves a limited number of places for international patients, so it is important to make an appointment timely. The work of specialists is aimed at achieving a long-term positive result for each patient; they give preference to the integrative therapeutic approach. The hallmark of German medicine is complementing the surgical treatment of obesity with conservative methods, working with a psychologist, and communicating with other patients in self-help groups.

The equipment of the hospital and the practical experience of doctors make it possible to treat patients with the most severe pathologies. German hospitals offer all types of surgical treatment for obesity, each of which is performed at the highest level.

Administrative work and organizational aspects of the trip are provided by the medical tourism company Booking Health, which annually helps hundreds of patients with morbid obesity in receiving effective treatment in the most specialized healthcare institutions.

To receive a consultation on the possibility of coming for the treatment, basic examination program, and planning further surgery, as well as receiving help in preparing necessary documents, you should leave a request on the website of the Booking Health company. After this, our patient case manager will contact you to clarify all the details and help you with preparing for the trip.

Booking Health company helps patients in such important aspects as:

• Getting an invitation for treatment from the clinic for faster medical visa receiving
• Getting an appointment on a convenient date and time
• Preliminary organization of comprehensive preoperative examination
• Providing transfer from the airport to the clinic and back to the airport
• Assistance of interpreter and personal medical coordinator
• Assistance in further surgical treatment organization, if necessary
• Providing medical insurance in case of complications (up to 200 000 euros)
• Preparation and translation of medical documents and recommendations from the clinic
• Help in further communication with your treating physician, if necessary

Our aim is to help you in saving and improving your health, don`t hesitate to contact us.

 

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Choose treatment abroad and you will for sure get the best results!

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Authors:

The article was edited by medical experts, board certified doctors Dr. Nadezhda Ivanisova, Dr. Sergey Pashchenko. For the treatment of the conditions referred to in the article, you must consult a doctor; the information in the article is not intended for self-medication!

 

Sources:

National Center for Biotechnology

Healthline

Medical News Today

 

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