Evidence-Based Guidelines for Bariatric Surgery: Commented Short Version

Evidence-Based Guidelines for Bariatric Surgery: Commented Short Version Background: Overweight and obesity have reached endemic dimensions in Germany. Consequently, the number of obesity procedures (bariatric surgery) is rising rapidly. These guidelines outline the implication of the increasing scientific evidence for bariatric surgery and its role within a multimodal treatment concept. Methods: Systematic literature search, classification of evidence, structured development of recommendation and interdisciplinary consensus. Results: Obesity operations are evidence-based treatment options that require a multidisciplinary evaluation and preparation, competent performance and long-term follow-up. The guideline extends the traditional BMI-based spectrum of indications (BMI > 40 kg/m(2) or > 35 kg/m(2) with associated complications) through the elimination of age restrictions and many contraindications. Surgery requires the exhaustion of a structured conservative therapy for a minimum of 6-12 months or the assumption of its failure. Diabetes mellitus type 2 is a potential indication criterion in patients with BMI < 35 kg/m(2) (metabolic surgery). The selection of patients for surgery is an individualized process. Standard techniques are laparoscopic gastric banding, gastric bypass, sleeve gastrectomy and biliopancreatic diversion. Postoperative follow-up care should be structured to prevent specific metabolic deficiencies and should be life-long, recognizing the chronicity of obesity. Conclusion: The guideline contains evidence-based recommendations for the indication of bariatric surgery, choice of procedure, technical aspects and follow-up. The implementation of the guideline in clinical practice and its recognition by health care providers will contribute to improved care of obese patients.