The population are getting older and obesity is growing. Laparoscopic sleeve gastrectomy (LSG) is increasingly used worldwide but is still used with skepticism in the elderly. The purpose of our analysis is to judge the security of LSG in patients older than 60 years compared to patients younger than 60 years.

To examine the association between the certification as bariatric surgery center and volume and patient outcome, data collected in the German Bariatric Surgery Registry were evaluated. All data were registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg.

Background: Gastric banding (GB) is a common bariatric procedure that is performed worldwide. Number of GB procedures is decreasing during the last years due to the reported long-term weight loss and long-term complications. Weight loss can be substantial after this procedure, but it is not sufficient in a significant portion of patients. Long-term rates for associated complications increase with every year of follow up, and only a few long-term studies have been published that examine these rates. We present our results after 20 years of postoperative follow up.Methods: Two hundred twenty eight patients were operated upon form 01.02.1995 to 31.01.2015. Data collection was performed prospectively. In retrospective analysis, we analyzed weight loss, short-and long-term complications, amelioration of comorbidities and long-term outcome.Results: The mean postoperative follow up time was 192 months (range 1-240). The follow up rate was 78.5%. The incidence of postoperative complications for slippage was 3.07% and pouch dilatation was 8.34%, for band migration was 5.26%. After 20 years rate of overall band removal was 26.75% and for reoperation alone 16.67%. Total rate of reoperations after was 43.42% resulting in a reoperation rate of 2.17% for every year of follow up. Excess weight loss was 39.2% after 1 year, 44.5% after 2 years, 43.0% after 5 years, 33.1% after 10 years, 38.8% after 15 years and 35.7% after 18 years of follow up. No patient has 20 years after operation the band still in place. Initially the number of patients experiencing in comorbidities was reduced, but during long term follow up many of them returned or developed new comorbidities.Conclusion: The complication and reoperation rate after GB is high. But for most of the other available procedures really eligible data on long term outcome and reoperation rate are missing. Nevertheless, GB is still a therapeutic option in morbid obese patients, but the criteria for patient selection should be carefully evaluated.

Background Bariatric surgery outcomes have been examined in Germany since January 1, 2005. All data were registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. Methods The data were collected from an online data bank. Data collection began in 2005 for gastric banding (GB) and Roux-en-Y gastric bypass (RYGB) results. In addition to primary bariatric operations, data regarding the complications of revision procedures and redo operations were analyzed. Participation in the quality assurance study was required for all certified centers in Germany. Results RYGBs are a popular redo operation after failed gastric banding. In the German Bariatric Surgery Registry (GBSR), we analyzed data from 263 RYGB operations that used a one-step approach after GB and 116 operations that used a two-step approach. The leakage rates for primary RYGB decreased to 1.8 %. The incidence of leakage after a one-step RYGB after GB was lower (1.9 %) than after the two-step procedure (2.6 %). Conclusion RYGBs are popular procedures after failed GB in Germany. The multivariable analysis for overall intraoperative complications revealed a significant difference between the two-step and the one-step procedure. In an unadjusted and multivariate assessment, the one-step procedure had statistically lower general postoperative complications than the two-step approach. Therefore, we suggest performing band removal and RYGB as a one-step procedure. Further analysis is necessary to evaluate the risk factors for the one-step procedure. Follow-up investigations must be performed to determine whether RYGB is an effective and safe option after GB.

BACKGROUND:Since 1 January 2005, bariatric surgery has been monitored in Germany. All related data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg.METHODS:Data collection regarding obesity and metabolic surgery was started in an online database in 2005. Follow-up data are collected once a year. Participation in the quality assurance study is voluntary.RESULTS:Since 2005, 10,330 Roux-en-Y gastric bypass (RYGB) procedures have been performed in Germany. In total, 8,013 patients were female and 2,317 were male. Male patients suffered significantly more comorbidities than female patients. The men also had higher body mass indexes (BMIs) and ages than the women at the time of operation. Data on the gender-specific aspects of RYGB from the Nationwide Survey of Bariatric Surgery in Germany (GBSR) showed a significant difference in anastomotic insufficiency at the gastro-entero-anastomosis. The leakage rate was 2.37 % (55/2,317) in men and 1.68 % (135/8,013) in women. Additionally, specific complication and mortality rates were significantly higher in male than in female patients.CONCLUSIONS:Metabolic and obesity surgery is becoming increasingly popular in Germany. Data from the GBSR show significant differences in preoperative comorbidities and postoperative complication and mortality rates between male and female patients. There is a need for further evaluation of gender-specific aspects to optimize patient selection and reduce specific postoperative complications.

Since 1 January 2005, the situation of bariatric surgery has been examined in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University Magdeburg. Data are registered in an internet online database. Data collection on the results of sleeve gastrectomy was started in 2006. Follow-up data were collected once a year. Participation in the quality assurance study is voluntary. Since 2005, 3,125 sleeve gastrectomies have been performed in 80 hospitals. The number of procedures has increased from 1 in 2005 to 1,564 in 2010. Initially, the leakage rate was 7 % in 2007. The leakage rate dropped to 1.7 in 2010. The mean age of patients was 43.5 years and mean body mass index (BMI) was 52.03 kg/m2. BMI and comorbidities are significantly higher in male than in female patients. The leakage rate in female patients was, at 1.60 %, significantly lower than in male patients, at 3.28 %. Sleeve gastrectomy is becoming more and more popular in Germany. But the postoperative complication rate is still high. Data from the nationwide survey of bariatric surgery in Germany show significant differences in preoperative comorbidities and complication rates between male and female patients. There is a need for further evaluation of gender-specific aspects to optimize patient selection and reduce specific postoperative complications.

Background Beginning January 1, 2005, the status and outcomes of bariatric surgery were examined in Germany. Data are registered in cooperation with the An-Institute of quality assurance in surgery at the Otto-von-Guericke-University Magdeburg. The objective of this study was to examine the morbidity and mortality rates secondary to sleeve gastrectomy (SG) in Germany since 2006. Methods Data collection occurred prospectively in an online data bank. All primary bariatric procedures performed were recorded as were all re-operations in patients that had already undergone a primary operation. Specific data compiled on the sleeve gastrectomy procedure were evaluated with a focus on operative details and complication rates. Results The total study cohort contains 3,122 patients. From January 2006 to December 2007, 144 sleeve gastrectomy procedures were performed in the 17 hospitals participating in the study. The mean body mass index (BMI) of all patients was 48.8 kg/m 2 . The BMI of patients undergoing SG was 54.5 kg/m 2 . In total, 73.8% of the patients were female and 26.2% of the patients were male. There were no significant differences between patients undergoing SG. The general complication rate after SG was 14.1%, and the surgical complication rate was 9.4%. The postoperative mortality rate was 1.4%. Conclusions The complication rate during the first 2 years after SG in Germany is similar to that published in the literature. In order to improve the quality of bariatric surgery, an evaluation of data from a German multicenter trial is necessary to evaluate the position of SG in the bariatric algorithm.

Since January 1st, 2005, the current situation for bariatric surgery has been examined by means of a voluntary quality assurance study in Germany with a multicenter design in which 38 hospitals and surgical departments participated. The data are registered in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany).

Zusammenfassung Hintergrund: Seit dem 1.1.2005 wird der aktuelle Stand der bariatrischen Chirurgie in Deutschland analysiert. Die Daten werden in Zusammenarbeit mit dem An-Institut für Qualitätssicherung in der Operativen Medizin an der Ottovon-Guericke-Universität Magdeburg erfasst und ausgewertet. Methoden: Die Datenerfassung erfolgt prospektiv mit einer Internetdatenbank. Zur Datenerfassung wurden alle Kliniken, die bariatrische Eingriffe durchführen, aufgerufen. Es werden alle Ersteingriffe, die seit dem 1.1.2005 erfolgten und alle Re-Eingriffe bei Patienten, die vor Studienbeginn operiert wurden, analysiert. Ergebnisse: Vom 1.1.2005 bis zum 31.12.2006 wurden insgesamt 1457 Patienten, die an 32 Kliniken operiert wurden, in die Studie eingeschlossen. Mit 42,8 % war das Gastric Banding die am häufigsten durchgeführte Operation, wobei der Roux-Y-Magenbypass bei 35,2 % erfolgte. Der mittlere BMI aller Patienten betrug 48,5 kg/m2 im Jahr 2005 und 48,4 kg/m2 im Jahr 2006. Nachuntersuchungsdaten konnten für 71,7 % der in 2005 operierten Patienten erfasst werden. Fazit: Ziel der Studie ist die Erfassung des aktuellen Standes der bariatrischen Chirurgie in Deutschland. Die in den einzelnen Einrichtungen angebotenen Operationsmethoden und die Häufigkeit bariatrischer Operationen werden detailliert untersucht. Die flächendeckende Ergebniserfassung und Analyse ist für die Bewertung der Versorgungssituation unter Alltagsbedingungen notwendig. Die Studie dient auch der kritischen Überprüfung der Indikationsstellung, operativen Qualität und postoperativen Nachbetreuung der Patienten.

A 63-year-old woman with BMI 46 underwent laparoscopic gastric banding. In the standardized follow-up after 14 and 24 months, the GI series and gastroscopy showed no pathological signs. The patient had hematemesis 32 months after gastric banding, followed by symptoms of obstruction, for which a laparotomy was performed. At operation, peritoneal carcinomatosis due to gastric cancer was found. Symptoms after bariatric procedures can be similar to symptoms of gastric or esophageal cancer. We believe that yearly postoperative gastroscopy is indicated to exclude pathological changes.

BACKGROUND:Adjustable silicone gastric banding (ASGB) is an effective treatment in morbid obesity. Band migration is a long-term complication. Causes, clinical symptoms, timing and incidence are investigated in single centres only. In Germany, since January 1st, 2005, practice in bariatric surgery has been investigated in German prospective multicenter trial for quality assurance in obesity surgery.MATERIALS AND METHODS:All patients underwent ASGB in two centres of bariatric surgery in Germany were prospectively registered using a computer-based data form. Patients with band migration were retrospectively evaluated, in particular, causes and characteristics of its management. The results were correlated with data obtained from the German prospective multicentre trial.RESULTS:In total, 493 patients were enrolled in the study from February 1995 to February 2007. The follow-up rate was 79.9% (mean follow-up time period, 78.7 months; range, 2-148 months). Fifteen patients (3.0%) developed migration. In 14 cases, migration occurred within the range of 30-86 months after implantation. In one case, migration occurred 10 months after repositioning of the band. In the German multicentre trial, 629 patients underwent surgery during 2005 and 827 patients in 2006. In both periods, 74.4% of the patients were female and 25.6% male. The most frequently performed operation was ASGB (46.8%) followed by Roux-en-Y gastric bypass (38.5%).CONCLUSION:Band migration requires band removal. Different symptoms and complications influence the kind of band removal. Multicentre data were evident in the case of high long-term complication rate after ASGB. Data of the German multicentre trial show the trend from restrictive bariatric procedures to malabsorptive approach.

Rhabdomyolysis is an uncommon event in bariatric surgery. It can be caused by ischemia, crush injury, alcohol ingestion and drug intake, and as a consequence renal failure can develop. A few reports indicate that patients undergoing bariatric surgical intervention are at risk for rhabdomyolysis. A super-obese male (BMI 52 kg/m2) is reported, who underwent laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS). Operative time was 265 minutes, and the BPD/DS operation was uneventful. Post-operatively, the patient complained of pain in both hips and the left shoulder, and suffered oliguria. He was treated with fluids (isotonic saline), bicarbonate, and mannitol. Despite this, he developed renal failure, which subsequently required hemodialysis. The patient died from arrhythmia and cardiac arrest on the 8th postoperative day. Obese patients undergoing bariatric surgery are at risk of rhabdomyolysis. Prolonged compression of the muscles during the surgical intervention, in long laparoscopic procedures, predisposes to this complication.

Having done 1 125 laparoscopic cholecystectomies we want to report an exceptional case of perioperative bowel lesion. The symptoms began with abdominal pain on the third postoperative day, followed by an evacuation of intestinal contents out of the Robinson-Drainage. The laparotomy showed a 4 mm lesion of the terminal ileum, which could be excised and closed. Any other complications were not recognized. The reason that caused the perforation could not be clarified. Possible mechanisms will be discussed.

Die Gastrointestinalen Stromatumoren (GIST) sind eine seltene, auch heute noch nicht vollständig aufgeklärte Gruppe von Neoplasien des Magen-Darm-Traktes. Trotz vieler Fortschritte der diagnostischen Möglichkeiten ist eine Zuordnung der GIST hinsichtlich ihrer Histogenese und Dignität nicht eindeutig. Im Zeitraum von 1/1994 bis 12/1999 wurden in der Klinik für Chirurgie 15 Patienten mit einem gastralen Stromatumor behandelt. Der Primärtumor konnte bei allen Patienten durch eine Ro-Resektion entfernt werden. Bei 6 Patienten kam es zu einer hämatogenen Lebermetastasierung, die Größe des Primärtumors betrug bei diesen Patienten mehr als 10 cm. Eine extrahepatische Fernmetastasierung ließ sich in allen untersuchten Fällen nicht nachweisen. Eine Lymphknotenmetastasierung konnte in den regionären Lymphknoten nicht festgestellt werden. Eine systematische Lymphadenektomie ist nicht indiziert. Die histologische Beurteilung der Dignität erfolgte auf der Grundlage der von Lewin, Weinstein und Riddell vorgeschlagenen Richtlinien. Das derzeitig gesicherte therapeutische Vorgehen besteht in der kurativen Resektion des Primärtumors sowie der Metastasen mit histologisch tumorfreien Resektionsrändern. Das Tumorrezidiv ist ebenso zu behandeln. Adjuvante oder neoadjuvante chemotherapeutische Ansätze zeigen bisher keine Erfolge.

Gastrointestinal stromal tumors (GIST), which form a rare group of neoplasias of the gastrointestinal tract, have not yet been fully investigated. Although good progress has been made in their diagnosis, classification of these lesions with regard to their histogenesis and biological behavior remains problematic. Between 1994 and 1998, 18 GIST patients underwere operation in the Department of Surgery. Twelve of these patients (67%) had stromal tumors in the stomach, and six (33%) had intestinal stromal tumors. The primary tumor could be removed in all patients with R0 resection. Six patients developed hematogenous liver metastasis, with the size of their primary tumor exceeding 10 cm. Extrahepatic distant metastases were not found in any case. Lymphadenectomy showed that lymph node metastases did not occur. Histological evaluation was made according to the guidelines of Lewin, Weinstein and Riddell. Currently established therapy is limited to complete surgical resection of the primary tumor and its metastases. Adjuvant or neoadjuvant chemotherapy approaches have failed.

Die nekrotisierende Fasziites ist eine sich rasch ausbreitende Entzündung des Epifaszialgewebes. Ein erhöhtes Erkrankungsrisiko besteht bei Patienten mit einem supprimierten Immunsystem. Insbesondere Patienten mit Diabetes mellitus, Ischämie der kleinen Gefäße, Tumorleiden, chronischem Drogenabusus und Adipositas sind überdurchschnittlich von der Erkrankung betroffen. Bakteriologisch wird eine Mischflora aus aneroben und äroben Keimen vorgefunden. Nach wie vor geht die Fasziites mit einer hohen Letalität einher. Nur durch eine frühzeitige Diagnose und eine sofortige, radikale chirurgische Intervention in Kombination mit einer adäquten postoperativen Wundversorgung kann die Prognose der Patienten verbessert werden. Bewährt hat sich die mehrmals tägliche Wundspülung mit 0,1%iger Lavasept®-Lösung (Polyhexanid). Kompromisse bei den Debridements sowie die alleinige Inzision und Drainage sind falsche Therapiekonzepte, die fatale Folgen haben können.