Bariatrische und metabolische Chirurgie in der integrativen Adipositastherapie: Ergebnisse, Methodik und Perspektiven

Background. Obesity and psychosocial atherogenic lipopathic metabolic syndrome (PSALMS) have developed into the most serious pandemic of our time. State-of-the-art treatment concepts include lifestyle modifications, behavioral therapies, pharmacotherapy, and invasive interventions. Metabolic bariatric endoscopy (MBE) encompasses intermittent and persistent restrictive methods. Metabolic bariatric surgery (MBS) includes merely restrictive and malabsorptive-restrictive surgical procedures.
Aim and methods. Narrative review of interventional endoscopic and surgical treatments of obesity and the integration of traditional Chinese
medicine (TCM) into multimodal treatment concepts.
Results. Five prospective randomized controlled trials (RCT) combined various acupuncture techniques with conventional antiemetic therapy (metoclopramide, granisetron, tropisetron, dexamethasone) after sleeve gastrectomy. In all studies, the integration of acupuncture into Western treatment concepts led to a significant improvement in postoperative nausea and vomiting. In two RCTs, intestinal transit was also successfully accelerated. In addition, antiemetics were used much later and less frequently overall, and hospital stays were shortened in one RCT.
Discussion. Acupuncture was able to optimize postoperative side effect management and should be evaluated as an (cost-)effective method for
inclusion in a standardized enhanced recovery after bariatric surgery (ERABS) program. Furthermore, other areas of application of TCM in MBE and MBS should be reconsidered and reviewed.