Lauerer Jakob, Kollmann Lars, Koschker Ann-Cathrin, Otto Mirko, Seyfried Florian
Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland.
Medizinische Klinik und Poliklinik I, Universitätsklinikum Würzburg, Würzburg, Deutschland.
Chirurgie (Heidelb). 2025 Sep 16. doi: 10.1007/s00104-025-02384-y.
Morbid obesity is a recognized chronic disease. Metabolic bariatric surgery (MBS) currently represents the most effective treatment, with efficacy in achieving significant weight reduction and improving obesity-related comorbidities, quality of life and overall survival; however, unsatisfactory treatment outcomes manifesting as suboptimal weight loss, recurrent weight gain, or poor control of comorbid conditions, represent a clinically relevant challenge requiring further treatment. Conversion surgery can positively influence weight trajectories and associated comorbidities but are associated with higher risk profiles compared to primary procedures. Additive pharmacological treatment, particularly glucagon-like peptide 1 (GLP-1) analogues, also demonstrate efficacy with an acceptable side effect profile. This article examines the definitions of suboptimal treatment success following MBS and provides an overview of available treatment options as well as the decision-making process for individualized treatment. Special attention must be paid to the comorbidities and the preferences of patients within an interdisciplinary framework supported by appropriate clinical expertise.
病态肥胖是一种公认的慢性疾病。代谢性减肥手术（MBS）目前是最有效的治疗方法，在实现显著体重减轻以及改善肥胖相关合并症、生活质量和总体生存率方面具有疗效；然而，表现为减肥效果欠佳、体重反复增加或合并症控制不佳的不理想治疗结果，是一个需要进一步治疗的临床相关挑战。与初次手术相比，转换手术可对体重变化轨迹及相关合并症产生积极影响，但风险更高。辅助药物治疗，尤其是胰高血糖素样肽1（GLP-1）类似物，也显示出疗效且副作用可接受。本文探讨了MBS后治疗效果欠佳的定义，概述了可用的治疗选择以及个体化治疗的决策过程。在具备适当临床专业知识支持的跨学科框架内，必须特别关注合并症和患者的偏好。
