Introduction In the literature, results after surgical treatment of non-colorectal non-neuroendocrine liver metastases (NCNNLM) are reported that are often inferior to those from colorectal liver metastases. The selection of patients with favorable tumor biology is currently still a matter of discussion. Materials/methods The retrospective data analysis was based on data that were collected for the multicenter study “Role of surgical treatment for non-colorectal liver metastases” in county Thuringia. Results For the study, 637 patients were included from 1995 to 2018. 5 and 10-year survival of R0 resected patients were 33% and 19%, respectively. In the multi-variate analysis of the entire group, sex, timing, disease-free interval, number of metastases, R-classification as well as lymph node status of the primary lesion showed an independent statistical influence on the 5-year survival. In the group of R0 resected patients, disease-free interval, number of metastases and lymph node status of the primary lesion influenced the 5-year survival in the multi-variate analysis. In kidney malignancies, R-classification, timing and number of liver metastases were statistically significant in the multi-variate analysis of the 5-year survival, in mamma carcinomas only the R-classification. Conclusion The Adam score identifies some risk factors which influence prognosis in most but not in all tumor entities. For kidney cancer and breast cancer it can be simplified.

The 2011 World Health Summit reported the epidemics of diabetes mellitus and morbid obesity. In Germany, 62.7% of the population have a BMI above 25 kg/m(2) and 21.9% above 30 kg/m(2). 10.5 patients per 100,000 inhabitants were treated with metabolic surgery, whereas in France 86.0 and in Sweden 114.8 patients per 100,000 inhabitants were given surgery. The development of endoscopic methods leads to the opportunity to bridge patients with a high risk profile before operation. Endoscopy is an excellent procedure with few complications. However, these methods need a selective and specialised concept of treatment. Endoscopy in metabolic surgery requires expertise in both endoscopy and in the techniques of metabolic surgery. The aim of the present paper is to report the new methods of endoscopy in the treatment of obese patients, on the basis of the literature and our own experience.

Background: Recently, sleeve gastrectomy (SG) has become one of the most important procedures in bariatric surgery. Short-term results show that SG is a feasible, safe, and effective operation treating obesity and its related co-morbidities. Now, the main focus is on long-term data after SG. Objectives: The aim of this study was to analyze perioperative and long-term results after SG in the German Bariatric Surgery Registry. Setting: National database, Germany. Methods: Perioperative data of primary SG (n=21525) and follow-up data for 5 years +/- 6 months (n=435, 18.3% of 2375 SG performed between 2005 and 2011) were analyzed. After a review of the literature long-term results were compared with international data. Results: Mean baseline body mass index (BMI) was 51.1 kg/m(2). Two hundred ninety-eight (68.5%) patients were female and 137 (31.5%) were male. Of patients, 90% had >= 1 co-morbidities. Mean operation time was 86 minutes. General postoperative complications occurred in 4.1% and special complications in 4.6% (staple-line leaks 1.6%). Mean maximum BMI loss was 18.0 +/- 6.8 kg/m(2) and BMI loss after 5 years was 14.3 +/- 7.4 kg/m(2) (P<.001). Co-morbidities, such as type 2 diabetes, hypertension, and sleep apnea, were significantly improved (P<.001). Gastroesophageal reflux was significantly impaired (P<.001). Conclusions: The current results showed that SG is a safe and effective procedure in bariatric surgery. BMI loss was significant 5 years after SG. Most co-morbidities were significantly improved, but gastroesophageal reflux has often worsened. The follow-up rate was very low, which is a persistent problem in German bariatric surgery. (C) (C) 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

„Die Gallenblase muss entfernt werden. Nicht, weil sie Steine enthält, sondern weil diese dort gebildet werden!“, sagte Carl Langenbuch vor über 130 Jahren. Das Grundanliegen hat weiter Bestand. Ziel des zweiteiligen Beitrags ist es, die aktuelle chirurgische Therapie des Gallensteinleidens darzustellen. Im Mittelpunkt stehen dabei in Teil 1 die Indikation zur Cholezystektomie und die Bewertung neuer Operationstechniken.

ZusammenfassungAuf dem World Health Summit 2011 wurde die epidemieartige Verbreitung von Diabetes mellitus und Adipositas bestätigt. In Deutschland weisen derzeit 62,7% der Bevölkerung einen BMI über 25 kg/m² und 21,9% einen BMI über 30 kg/m² auf. Derzeit erhalten 10,5 Betroffene pro 100 000 Einwohner einen adipositaschirurgischen Eingriff, währenddessen in Frankreich 86,0 Betroffene und in Schweden sogar 114,8 Betroffene pro 100 000 Einwohner operiert werden. Die Entwicklung zahlreicher endoskopischer Techniken ermöglicht die Konditionierung (Bridging) von Hochrisikopatienten vor dem Einsatz operativer Methoden ebenso wie im therapeutischen Management chirurgischer Komplikationen. Dies erfordert jedoch ein selektives und spezialisiertes Vorgehen. Die Endoskopie in der Adipositas entwickelt sich aktuell zunehmend zu einem Spezialgebiet, das Erfordernis der Kenntnis der metabolisch-chirurgischen Methoden mit spezieller endoskopischer Expertise verbindet. Das Ziel der vorliegenden Übersicht ist es, basierend auf ausgewählter Literatur und eigenen Erfahrungen die aktuellen Konzepte der Endoskopie mit ihren Besonderheiten darzustellen.

ZusammenfassungDie zunehmende Prävalenz der morbiden Adipositas geht auch in Deutschland mit einer deutlichen Zunahme von adipositas- und metabolisch-chirurgischen Eingriffen einher. Die Adipositas ist häufig mit Fertilitätsstörungen assoziiert. Mit einer Häufigkeit von 6 – 10% stellt das polyzystische Ovarsyndrom (PCOS) eine häufige Ursache der Infertilität dar. Die damit assoziierten metabolischen und kardiovaskulären Folgen bedeuten ein erhebliches Gesundheitsproblem. Metabolisch-chirurgische Eingriffe können die Fertilität dieser Frauen deutlich verbessern. Aufgrund der Effektivität der metabolischen Chirurgie hinsichtlich der Gewichtsreduktion, der Rückbildung der Komorbiditäten sowie der Lebensqualität und der Fertilität im Vergleich mit konservativen Verfahren hat die Bedeutung der Adipositaschirurgie erheblich zugenommen. Metabolische Defizite können Folge diverser restriktiver, kombinierter und malabsorptiver Operationsmethoden sein. Ihre Prophylaxe bei Schwangerschaft nach bariatrischer Operation erfordert eine intensive und interdisziplinäre Versorgung der Schwangeren. Ziel der vorliegenden Arbeit ist es, die Problematik der nutritiven Mangelzustände und deren Prophylaxe in Zusammenhang mit einer Gravidität darzustellen.

„Die Gallenblase muss entfernt werden. Nicht, weil sie Steine enthält, sondern weil diese dort gebildet werden!“, sagte Carl Langenbuch vor über 130 Jahren. Das Grundanliegen hat weiter Bestand. Ziel des zweiteiligen Beitrags ist es, die aktuelle chirurgische Therapie des Gallensteinleidens darzustellen. Im Mittelpunkt stehen dabei in Teil 2 neue Gesichtspunkte beim „komplizierten Steinleiden“ und das Komplikationsmanagement.

The increasing prevalence of morbid obesity in Germany is associated with an increasing number of metabolic surgical interventions. Short-term surgical and long-term metabolic complications - such as nutrient deficiencies - are the main risks of metabolic surgery and the resulting malabsorption. Obesity, especially morbid obesity, is associated with a high incidence of female infertility. One important cause of female infertility in obese women is the polycystic ovary syndrome, with 6-10%. Metabolic surgery significantly increases the fertility of obese women. The positive effect of obesity surgery on weight loss, remission of comorbidities, psychological outcome and fertility (in comparison with the effect of conservative treatment) has led to an increase in the number of metabolic operations. Nutrient deficiencies after restrictive, combined and malabsorptive procedures must be considered. Prophylaxis of these deficiencies during pregnancy after obesity surgery must be based on intensive interdisciplinary treatment. The aim of this overview is to characterise the metabolic complications and their prophylaxis, which are specific for the various bariatric procedures and which, subsequently, require temporary or permanent surveillance and supplementation.

Staple line leak after laparoscopic sleeve gastrectomy (LSG) still represents the most feared complication. The purpose of this study was to investigate whether there are factors that increase the risk for a leakage. Furthermore, we aimed to analyze the impact of a leak on weight change and resolution of comorbidities.

The increasing prevalence of morbid obesity in Germany is associated with an increasing number of metabolic surgical interventions. Short-term surgical and long-term metabolic complications such as nutrient deficiencies can be considered as the main risks of metabolic surgery with its malabsorptive but also restrictive procedures. The aim of this review was to characterize the most relevant metabolic complications specific for the various bariatric procedures, which, subsequently, require a permanent surveillance and supplementation, respectively. Furthermore, we aimed to identify if there are diagnostic and therapeutic measures that can prevent those complications. Restrictive bariatric surgery such as "gastric banding" and "sleeve gastrectomy" can be associated with deficiencies related to B-vitamins whereas iron, folate, vitamin B1, B12 and D deficiencies are associated with the malabsorptive procedure such as "biliopancreatic diversion," "duodenal switch" and "Roux-en-Y gastric bypass". Due to possible metabolic and surgical complications after bariatric surgery, patients need to undergo life-long medical and dietetic surveillance. The recently published guidelines of the "American Association of Bariatric and Metabolic Surgery" are the basis for recommendations on supplementation and treatment following weight loss surgery.

Zusammenfassung Hintergrund Die Adipositas repräsentiert eines der ernsthaftesten medizinischen Probleme unserer Zeit. Neben der Zunahme der Adipositas im Erwachsenenalter zeigt sich auch bei Jugendlichen eine besorgniserregende Entwicklung. Die bariatrische Chirurgie hat sich zu einer sicheren und effektiven Therapieoption bei Adipositas im Erwachsenenalter etabliert. Bei Jugendlichen werden diese Eingriffe noch kontrovers diskutiert. Die derzeit verfügbare Evidenz bez. Sicherheit und Effektivität ist limitiert. Material und Methoden Im Rahmen der multizentrischen Beobachtungsstudie „Qualitätssicherung in der operativen Therapie der Adipositas“ werden seit dem 01.01.2005 die Daten von Patienten, die sich in Deutschland wegen einer Adipositas einem chirurgischen Eingriff unterzogen haben, prospektiv erfasst. Für die vorliegende Studie wurden alle Patienten berücksichtigt, bei denen im Zeitraum von 01.01.2005 bis 31.12.2014 ein primärer Roux-Y-Magenbypass (RYGB) wegen einer Adipositas durchgeführt wurde. Ergebnisse Insgesamt wurden 370 Jugendliche (≤ 21 Jahre) und 16 840 Erwachsene untersucht. Im Jahr 2014 repräsentierte der RYGB den zweithäufigsten bariatrischen Eingriff für beide Gruppen. Bei den Jugendlichen zeigte sich ein höherer initialer BMI (49,2 vs. 47,9 kg/m2, p < 0,01), der Anteil assoziierter Nebenerkrankungen war niedriger (67,8 vs. 87,4%, p < 0,01). Die Operationsdauer (104,9 vs. 113,0 min, p < 0,01) sowie die Krankenhausverweildauer (5,2 vs. 5,9 Tage; p < 0,01) unterschieden sich signifikant zwischen beiden Gruppen. Keiner der jugendlichen Adipösen entwickelte eine Anastomoseninsuffizienz, verglichen mit einer Leckagerate von 1,6% bei den Erwachsenen (p = 0,04). Die Mortalitätsrate betrug 0,2% in der Gruppe der Erwachsenen. Keiner der adipösen Jugendlichen verstarb postoperativ. Der mittlere prozentuale Übergewichtsverlust (% EWL) war nach 12 (69,9 vs. 68,2%; p = 0,97) bzw. 24 Monaten (72,6 vs. 72,1%; p = 1,0) für beide Gruppen vergleichbar. Bei Jugendlichen mit vorbestehender arterieller Hypertonie fand sich im Vergleich zu Erwachsenen eine höhere Remissionsrate. Schlussfolgerung Der RYGB kann bei jugendlichen Adipösen mit einer niedrigeren Morbidität und Mortalität durchgeführt werden. Trotz aller Limitierungen einer Registerstudie und der geringen Follow-up-Rate zeigt sich, dass die Ergebnisse im kurzfristigen Verlauf denen nach RYGB bei Erwachsenen mindestens vergleichbar sind. Der Fokus zukünftiger Studien muss auf der Evaluation des Langzeitverlaufs liegen.

Morbid obesity in both adolescents and adults has risen in an alarming rate. Bariatric surgery is playing an increasing role in pediatric surgery. However, current evidence is limited regarding its safety and outcome.

BACKGROUND:Laparoscopic sleeve gastrectomy (SG) is an upcoming procedure in bariatric surgery and is currently performed worldwide. Staple line leakage, as the most frequent and most feared complication, is still a major concern.METHODS:Since 2005 data from patients undergoing bariatric procedures in Germany have been prospectively registered in an online database and analyzed. All patients who had undergone primary SG within a 7-year period were considered for analysis.RESULTS:Using the German Bariatric Surgery Registry, data from more than 11,800 SGs were collected between January 1, 2005, and December 31, 2013. Staple line leak rate decreased from 6.5% to 1.4%. Male sex, higher body mass index, concomitant sleep apnea, conversion to laparotomy, longer operation time, a combination of buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate compared with when using either buttresses or oversewing alone. On multivariable analysis, operation time and year of procedure only had a significant impact on staple line leakage rate.CONCLUSIONS:Owing to the growing experience a constant decrease in the leakage rate after SG has been observed. Staple line disruption may still lead to sepsis, multiorgan dysfunction, and increased mortality. The results of the current study demonstrated that there are factors that increase the risk of leakage and which would enable surgeons to define risk groups, select patients more carefully, and offer closer follow-up during the postoperative course with early recognition and adequate treatment.

BACKGROUND:Increasing experience with minimally invasive surgery and the development of new instruments has resulted in a tendency toward reducing the number of abdominal skin incisions. Retrospective and randomized prospective studies could show the feasibility of single-incision surgery without any increased risk to the patient. However, large prospective multicenter observational datasets do not currently exist.OBJECTIVE:This prospective multicenter observational quality study will provide a relevant dataset reflecting the feasibility and safety of single-incision surgery. This study focuses on external validity, clinical relevance, and the patients' perspective. Accordingly, the single-incision multiport/single port laparoscopic abdominal surgery (SILAP) study will supplement the existing evidence, which does not currently allow evidence-based surgical decision making.METHODS:The SILAP study is an international prospective multicenter observational quality study. Mortality, morbidity, complications during surgery, complications postoperatively, patient characteristics, and technical aspects will be monitored. We expect more than 100 surgical centers to participate with 5000 patients with abdominal single-incision surgery during the study period.RESULTS:Funding was obtained in 2012. Enrollment began on January 01, 2013, and will be completed on December 31, 2018. As of January 2016, 2119 patients have been included, 106 German centers are registered, and 27 centers are very active (>5 patients per year).CONCLUSIONS:This prospective multicenter observational quality study will provide a relevant dataset reflecting the feasibility and safety of single-incision surgery. An international enlargement and recruitment of centers outside of Germany is meaningful.TRIAL REGISTRATION:German Clinical Trials Register: DRKS00004594; https://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00004594 (Archived by WebCite at http://www.webcitation.org/6jK6ZVyUs).

BACKGROUND The current situation in obesity and metabolic surgery since January 2005 has been investigated with the help of the quality assurance study on surgical therapy for obesity = German Bariatric Surgery Registry (GBSR). The data were acquired and analysed in cooperation with the Institute for Quality Assurance in Surgical Medicine at the Otto-von-Guericke University. METHODS Data acquisition was done with the help of an online database. On a voluntary basis, all obesity and metabolic surgical interventions since 2005 have been recorded. In addition to the surgical data, the findings of the yearly follow-up investigations were recorded. RESULTS Since 2005 there have been 1,263 gastric balloon procedures, 11,840 sleeve gastrectomies, 13,722 Roux-en-Y gastric bypasses and 3999 gastric banding operations. The average age of the male patients in all interventions was significantly higher. The average BMI of female patients who received a gastric banding or a gastric balloon procedure was significantly lower than that of the male patients. Men exhibited a higher incidence of comorbidities than women. CONCLUSION The number of obesity and metabolic surgical interventions in Germany is continuously increasing. The results of the study on surgical therapy for obesity (GBSR) reveal significant differences in the gender-specific incidence of preoperative comorbidities. postoperative complications and mortality. Further studies on gender-specific aspects are necessary in order to optimise patient selection and reduce the incidence of postoperative complications.

BACKGROUND:Laparoscopic sleeve gastrectomy (LSG) is currently being performed with increasing frequency worldwide. It offers an excellent weight loss and resolution of comorbidities in the short term with a very low incidence of complications. However, the ever present risk of a staple line leak is still a major concern.METHODS:Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered in an online database and analyzed at the Institute of Quality Assurance in Surgical Medicine. For the current analysis, all patients that had undergone primary sleeve gastrectomy for morbid obesity within a 7-year period were considered.RESULTS:Using the GBSR, data from 5.400 LSGs were considered for analysis. Staple line leak rate decreased during the study period from 6.5 to 1.4 %. Male gender, higher BMI, concomitant sleep apnea, conversion to laparotomy, longer operation time, use of both buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate. On multivariate analysis, operation time and year of procedure only had a significant impact on staple line leak rate.CONCLUSIONS:The results of the current study demonstrated that there are factors that increase the risk of a leakage which would enable surgeons to define risk groups, to more carefully select patients, and to offer a closer follow-up during the postoperative course with early recognition and adequate treatment. All future efforts should be focused on a further reduction of serious complications to make the LSG a widely accepted and safer procedure.

Background: Since January 2005, the status of bariatric surgery in Germany has been examined in conjunction with a quality assurance study of the German Bariatric Surgery Registry (GBSR). All data are registered prospectively in cooperation with the Institute for Quality Assurance in Surgical Medicine at the Otto-von-Guericke University Magdeburg, Germany. Methods: Data are registered in an online database. Data collection on obesity and metabolic surgery is voluntary, and was started in 2005. In addition, follow-up data are collected once a year. Results: Since 2005, 8,293 sleeve gastrectomies, 10,330 Roux-en-Y gastric bypass procedures, and 3,741 gastric banding procedures have been performed in Germany, according to the data of the GBSR. Mean age and mean body mass index of female patients with gastric banding, sleeve gastrectomy, or Roux-en-Y gastric bypass were significantly lower than those of male patients. The incidence of relevant comorbidities was significantly higher in male than in female patients. Conclusion: Metabolic and obesity surgery is becoming more and more popular in Germany. Data from the GBSR study 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.