[Sleeve gastrectomy as a revision procedure for failed gastric banding]. / Schlauchmagenbildung als Revisionseingriff nach Magenbandversagen.

The number of bariatric surgical procedures is still increasing in Germany and also worldwide. According to the German quality assurance study of surgical treatment of obesity, the laparoscopic adjustable gastric banding (LAGB) was the most common bariatric operation with a total of 678 cases between 2004 and 2006 in Germany. In the meantime a high rate of LAGB treatment failures has been reported, so that a high rate of revisional bariatric operations is required. But still the question is open which bariatric procedure can be recommended. The aim of this study is to report the results and follow-up of conversion of failed LAGB to laparoscopic sleeve gastrectomy (LSG). Between 8/2008 and 4/2012 39 patients (31♀/8♂) with a mean age of 43.7 ± 7.8 (26-61) years and a BMI of 47.1 ± 9.1 (30.4 to 67.4) kg/m² had revisional surgery for converting a failed LAGB to LSG. The indications for conversion were dysphagia (38.5 %), weight regain (33.3 %), band slippage (17.9 %), band erosion (5.1 %), band defect (2.6 %) as well as band sepsis (2.6 %). 19 procedures were performed as a one-stage operation and 20 procedures as a two-stage operation. The average operating time was 129 ± 49 (50-312) min. The complication rate was 7.7 %. There were one proximal leak, one gastric sleeve stenosis and one pronounced wound infection. The percent excess weight loss was 23 %, 39 %, 51 %, 52 %, 60 % and 46 % after 1, 3, 6, 12, 24 and 36 months follow- up, respectively. Converting a failed LAGB into a LSG is a revision procedure with low complication rate and promising results, which can be performed as a two-stage as well as a one-stage procedure.

[Combined pancreas/kidney transplantation as standard procedure in therapy of type I diabetic patients in renal failure]. / Die kombinierte Pankreas-/Nierentransplantation als Standardverfahren in der Therapie niereninsuffizienter Typ-I-Diabetiker.

Sinde the introduction of the bladder drainage technique, the number of pancreas transplants performed has now reached 1000/year worldwide. Most of these transplants have been performed in the United States. In contrast, the number of pancreas transplants performed in the Eurotransplant community has remained at a low level for several years. The results of a consecutive series of 20 simultaneous pancreas/kidney grafts (SPK) performed between June 1994 and October 1995 demonstrate that high graft function rates of 83.5% for pancreas and kidney grafts can be achieved. Therefore SPK can be recommended as a standard procedure for patients with insulin-dependent diabetes mellitus and end-stage renal disease in Germany, too.

[Sleeve gastrectomy in the treatment of morbid obesity. Study results and first experiences with the transvaginal hybrid NOTES technique]. / Schlauchmagenbildung in der Behandlung der morbiden Adipositas : Studienergebnisse und erste Erfahrungen mit der transvaginalen Hybrid-NOTES-Technik.

BACKGROUND: Surgery for morbid obesity is also becoming more important in Germany. Besides standard procedures such as the Roux-en-Y (RNY) bypass, sleeve gastrectomy seems to be a new option which is mainly related to gastric restriction, neurohumoral changes and other unknown factors. The results of sleeve gastrectomy have to be compared with other established procedures such as the RNY bypass according the complication rate, weight loss and improvement of weight-related comorbidities such as diabetes and hypertension. PATIENTS AND METHODS: Between May 2008 and August 2009 sleeve gastrectomy was performed in a total of 200 patients (136 female and 64 male) with an obesity grade II-III. The average age of the patients was 43 years (range 21-72 years) and the average BMI 47.9 kg/m(2) (range 35.5-75.3 kg/m(2)). Of the patients 70 (35%) were diabetics and 96 (48%) suffered from hypertension. In 14 cases the operation was planned using the transvaginal assisted (hybrid NOTES) technique. RESULTS: Laparoscopic sleeve gastrectomy was possible in all patients. Of the patients 3 (1.5%) suffered from postoperative complications, such as leakage from the suture line in 2 (1%) cases and in 1 case (0.5%) with hemorrhaging from the abdominal wall and subsequent pulmonary embolism resulting in a mortality rate of 1% (2 cases). In the 197 cases without complications the mean hospital stay was 3.5 days (range 2-9 days). Using the transvaginal technique the number of trocars could be reduced by 1-2 and in all cases the resected stomach was retrieved transvaginally. No complications occurred due to the vaginal access. Antidiabetic medication was stopped 3 months after the operation in 45 (64%) out of 70 diabetics and the need for antihypertension drugs was also reduced. The mean weight loss after 3, 6 and 12 months was 27.3%, 41% and 58%, respectively. CONCLUSIONS: Sleeve gastrectomy seems to be an effective surgical option for the treatment of morbid obesity with a low complication rate. During the first year after the operation weight loss was excellent and weight-related comorbidities such as diabetes and hypertension improved significantly. The transvaginal hybrid NOTES technique can be performed but there is still need for additional trocars through the abdominal wall. Long-term results with respect to a durable weight loss and obesity-associated comorbidities are still lacking. The results of sleeve gastrectomy are at present comparable to those of a RNY bypass.