Zusammenfassung
Unter dem Aspekt der gesellschaftlich relevanten Prävalenz der weiblichen Adipositas von bis zu 40% in den Industrienationen stellen die elektive, die onkologische, aber besonders die notfallmäßige operative Versorgung extrem übergewichtiger Patientinnen in der Gynäkologie spezielle Anforderungen an Ausstattung, Logistik und Kompetenz von Kliniken und Ärzten. Dabei reicht das typische Spektrum der Operationen bei Fettleibigkeit in der Gynäkologie von den Routineeingriffen zur Behebung von Deszensus und Harninkontinenz über große onkologische Beckenchirurgie bis hin zu plastisch-ästhetischen bzw. medizinisch indizierten Eingriffen wie Mammareduktions- und Abdominoplastik. Grundsätzlich profitieren adipöse Patientinnen aufgrund der deutlich geringeren Wundheilungsproblematik von den Möglichkeiten der minimal-invasiven Chirurgie, sodass die laparoskopischen Verfahren dem offenen abdominalen Vorgehen vorzuziehen sind. Zur Vermeidung intra- bzw. peri- und postoperativer Komplikationen sind sowohl die apparativen Ausstattungen, z. B. mit Bereitstellung entsprechend tragfähiger Operationstische, als auch die diagnostischen und operativen Besonderheiten bei Fettleibigkeit zu beachten und ggf. spezialisierte operative Zentren auszuwählen.
Abstract
The socially relevant prevalence of female obesity is up to 40% in western countries and requires a high level of specialization in technical and professional competence of hospitals and gynecological operating teams treating these patients. Typical procedures in gynecological surgery of morbidly obese women range from correction of descensus uteri and incontinence to oncological pelvic surgery and specifically indicated operations, such as reduction mammoplasty and abdominoplasty. There is evidence that due to significantly reduced wound healing problems obese patients will benefit most from minimally invasive surgery and laparascopic techniques should be the preferred procedure compared to open abdominal access. To avoid intraoperative, perioperative and postoperative complications in obese patients, technical aspects such as sustainable operating tables as well as special diagnostic and surgical features have to be taken into account and it seems advisable to establish specialized centers for treatment of morbidly obese patients.
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Nestle-Krämling, C. Perioperative Betreuung übergewichtiger Patientinnen in der Gynäkologie. Gynäkologe 44, 891–897 (2011). https://doi.org/10.1007/s00129-011-2832-5
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DOI: https://doi.org/10.1007/s00129-011-2832-5