Obesity Clinic, UKE Hamburg, Germany

The Obesity Clinic offers a range of assistance for obese patients, including extreme forms, over 60 Kg/m².

Specialist treatments < Obesity < UKE Obesity

Universitätsklinikum Hamburg-Eppendorf (UKE)

University Medical Centre, Hamburg, Germany

Obesity Clinic

No unstable psychiatric illnesses, alcohol abuse, or drug use

Body mass index > 35kg/m² with serious comorbidities

Obesity present for more than 5 years

The Deutsche Gesellschaft für Adipositas (German Obesity Society) and the International Federation of Surgery of Obesity (I.F.S.O.) require the following selection criteria for surgical treatment of obesity:

For information on the University Medical Centre, Hamburg-Eppendorf, visit the UKE page.

Body mass index > 40kg/m²

Exclusion of metabolic disorders

Minimally invasive, single port techniques

Drug therapy to treat obesity is an option for patients with a BMI (body mass index) of at least 27 kg/m² and simultaneous presence of obesity-related diseases (e.g., type 2 diabetes mellitus or hypertension) or a BMI of at least 30 kg/m² without associated diseases.

Drug therapy

If conservative (non-surgical) treatment options fail, surgical procedures for treating obesity may be a last resort for certain patients. The optimal treatment for each individual case can be recommended only after a comprehensive evaluation.

Surgery

Ability of the patient to cooperate

Acceptable surgical risk

All surgical procedures are minimally invasive, i.e. using the keyhole technique (laparoscopy). In suitable patients the single-port technique (SILS, only one trocar) or passage through natural body openings (NOS, NOTES) can be considered. These innovative methods reduce postoperative pain and offer better cosmetic results since they are mostly invisible.

Dietary modifications and exercise therapy should be attempted first; drug therapy should be considered only if these approaches are not successful.

The Clinic currently uses two substances to encourage weight reduction: Amfepramon (Regenon®) and Orlistat (Alli®). The determination to use drug therapy and the selection of the compound are made by the doctor on a case by case basis.

Gastric band

During gastric band surgery an adjustable band is placed around the stomach laparoscopically (keyhole technique), dividing it into a small new stomach close to the esophagus and a residual stomach. The band constricts the passage between the small stomach and the large residual stomach to 8-10 mm, so that food collects in the small stomach after swallowing

The gastric band is an aid that can facilitate weight loss by reducing food intake. Prerequisites for successful and sustainable weight loss are exercise and a permanent change in diet. Inside the gastric band is a balloon which can be filled via a subcutaneous port system, regulating the width of the passage.

Stretch receptors located in this portion of the stomach induce a feeling of fullness. The food then passes in a delayed fashion through the normal digestive tract.

The operation usually requires a hospital stay of one week. If all goes as planned, the patient loses approximately 50% of his excess weight over time. The gastric band usually remains in the body for life and is removed only in case of complications.

Sleeve gastrectomy

Sleeve gastrectomy is a restrictive procedure during which a large portion of the stomach is removed and only a tube (or sleeve) along the lesser curvature remains as a connection between the oesophagus and the small intestine. The stomach thus loses much of its capacity, ensuring that only small portions can be ingested.

This surgery is usually performed only as part of a combined restrictive/malabsorptive procedure. Currently, sleeve gastrectomy is used as a sole measure only in isolated cases.

Gastric bypass

Gastric bypasses are among the most commonly used surgical procedures. Sections of the small intestine are bypassed to reduce the surface area for absorption. Sometimes this is combined with a simultaneous gastric restriction procedure.

The length of the individual loops and the joining point of the stomach and small intestine depend on the BMI and the overall length of the small intestine and are determined individually. The size decrease of the stomach results in a reduction of food intake. Because of the partial separation of chymus from bile and pancreatic secretion during the passage through the small intestine, less of the small intestine is available for absorption and less food can be digested.

After the operation the patient must take certain vitamin, iron, mineral, and trace element supplements for the rest of his life.

In cases of obesity with BMI>50 it is difficult to achieve the desired result with a purely restrictive procedure (e.g., gastric band). Bypass procedures are preferred in these cases. One surgical procedure is the duodenal switch operation. This consists of a stomach reduction by means of a sleeve procedure and a malabsorptive aspect with a relatively short common small intestinal channel.

Duodenal switch

In cases of extreme obesity or for certain risk profiles, this procedure can be carried out in two steps. The first step is a minimally invasive sleeve procedure which initially leads to a significant reduction in weight. If the weight loss stagnates, the duodenal switch is completed.

Biliopancreatic diversion

An alternative to the duodenal switch is the biliopancreatic diversion. This procedure also consists of a stomach reduction and a malabsorptive aspect with a relatively short common small intestinal channel.

Remedial operations

In rare cases in which an implanted band has not led to sufficient weight loss or has caused undesirable results, conversion into gastric bypass might be required. After laparoscopic removal of the gastric band a gastric bypass procedure can be performed. In some cases a minimally invasive conversion of a gastric band into a gastric sleeve or of a gastric sleeve into a gastric bypass is required.

Priv.-Doz. Dr. med. Oliver Mann

Priv.-Doz. Dr. med. Jens Aberle

When using this technique, attention must be paid to postoperative deficiency symptoms. However, the expected weight loss is greater than for a normal Roux-en-Y gastric bypass.

The advantage of this method is that, in addition to the significantly reduced weight, the surgery risk has significantly lessened by the time the second, more difficult operation is performed.

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All patients and their families are supported with translation service, airport shuttle, driver service and many other administrative services provided by the International Office of the UKE.

Hamburg University Hospital meal service

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