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If you suffer from obesity and cannot achieve a positive impact on weight loss with a diet, there is an option to have an appropriate weight loss surgery. Both in Germany and in Austria we are very familiar with such experts for the surgical removal of obesity. In the department, this topic is called bariatric surgery.

Bariatric surgery is a branch of surgery that deals with the surgical procedures to enable a rapid and effective reduction in body weight in case of overweight.

Bariatric surgery actually leads to rapid weight loss of the patient. By reducing the size of the stomach or partially resecting the small intestine, the patient can absorb less nutrients and lose weight.

Most bariatric procedures are performed endoscopically in the abdomen. Due to the reduced stomach content, bariatric surgery leads to less food intake and a faster feeling of satiety. Bypassing (also known as bypass) is a part of the small intestine that is responsible for the absorption of important vitamins and minerals. By bariatric patients, these can hardly be absorbed by the body, so that the supply of nutritional supplements is necessary.

At the same time, the hanging of the abdominal wall is usually removed to additionally underline an aesthetic effect. As a rule, these interventions can be carried out without any problems.

You may kindly get a piece of advice from one of our bariatric surgeons. Kindly send us a description of your case.

We are looking forward to helping you soon.

GermanMedicalGroup + 49 (7221) 39-65-785 Flugstrasse 8a
76532 Baden-Baden
According to the latest WHO studies, over 25% of people are obese, meaning they have a BMI of more than 30 kg / m². In most cases, only surgery helps to reduce obesity. There are a number of renowned experts in German clinics who use their perfect op-techniques to reduce obesity. Our information and the contact details of these experts can be found here 2020-03-27 Bariatric Surgery
Bariatric Surgery

During last 10 years we have had an experience with the data of more than 45000 patients from all over the world. The choice of the treatment depends on the individual case. There is no standart. Germany is one of the leading countries in a quality of as obesity treatments as well as a diabetis type 2. The quantity of bariatric surgeries, in relation to the population, is definitly lower than in the neighbouring contries. Nowadays the frequency of bariatric surgeries in case of morbid obesity is currently 10.5 per 100 000 adults, what is much higher as in the other European countries (Sweden: 114.8, France: 86.0, Switzerland: 51.9). It is many times higher in other European countries (Sweden: 114.8, France: 86.0, Switzerland: 51.9).

There is no special standard for any bariatric interventions. The choice of the bariatric surgery is always strictly individual and depends on the very special case of the patient.

The German Bariatric Surgery Register (GBSR) follows the analytical situation in bariatric surgery branch since 2005. This observational study, also known as "Quality Assurance Study of Adiposity Operative Surgery", provides comprehensive information based on diagnostics, surgical therapy, postoperative course and long-term outcome of metabolic-surgical interventions of more than 45 121 patients.

The average age of the patients is about 42.7 years, with 71.5% (n = 28 395) significantly more women than men (28.5%, n = 11 316). The obesity-associated co morbidities, increase steadily during the observation period, with 90.26% of men and 85.05% of women, having, at least, one of co morbidity to their surgery time. At 50.67 kg / m2 Usually men have a significantly higher BMI than women ( 50.67 kg / m2 in comparison to 48.69 kg / m2).

The number of obese people is increasing dramatically worldwide. You can even say that the disease is spreading like an epidemic or even a pandemic. According to the current WHO data, approximately 21.3% of German citizens are obese, i.e. they have a BMI of more than 30 kg/m².

BMI of 35 kg/m² is considered the Obesity Grade II, BMI of more than 40 kg/m² is the Obesity Grade III. The health implications are dramatic: obesity causes numerous secondary diseases, mostly diabetes mellitus and cardiovascular diseases. Moreover different types of cancer are more common by obese people than by people with normal weight.

In addition, the obese person is impacted economically because of high health costs and trying to lead the healthy mode of life without a previous therapy.

Because of morbid obesity individuals usually experienced a significant reduction of quality of life, they are also often confronted with social exclusion and prejudice. Surely every obese person has heard the well-intentioned advice: "Eat less and move more", even though this advice certainly is a good way to prevent obesity, it does not provide an effective therapy. Overweight patients who in addition to exertional dyspnea also have severe pain or degeneration, will only be able to follow this recommendation partially.

At the same time, modern people are moving less, hard physical work has become much rare, cheap high energy food is everywhere and is aggressively advertised. All these factors have contributed to the sudden increase in obesity, seen since the 1970s in almost all industrial and newly industrializing countries.

Since conservative therapy has a rather low efficiency and therefore cannot solve the problem for the majority of patients, surgical procedures have been developed that can change the anatomy and physiology of food intake to make the rapid and sustainable weight loss possible.

The United States of America is obviously ahead of Germany in the development of obesity. The number of surgical interventions to treat morbid obesity has increased in such a way that they have already overtaken the two most frequent interventions: gallbladder removal and hernia operation. These interventions are being carried out more and more often in Europe, too.

Prerequisites for treatment

An operative reduction of pathological excess weight always represents a considerable intervention in the body anatomy and physiology and sometimes influences a critically on food digestion and metabolism. In addition, there are always risks associated with a major surgical procedure. Therefore, a surgical treatment should never be the first option, it can be chosen only if all other therapy methods have failed or promise no success.

At present, these kind of surgeries are not reimbursed by health insurance companies by default, each intervention must be applied for and motivated individually. A health insurance company will take over the costs of such an op, taking into account not only medical criteria of its usefulness, a patient should also complies with further conditions. The following criteria should be met:

  • Patients should be between 18 and 65 years old.
  • Their BMI should be greater than 40 kg/m² or if the BMI is over 35 and patients suffer from health problems that are associated with severe excess weight, e.g. diabetes, joint diseases, heart problems or snoring with regular suspending of respiration (sleep apnea).
  • The patient has been overweight for more than 5 years.
  • A multimodal conservative therapy has been conducted for more than 6 months and had no effect.
  • Patients have no other diseases that could cause the overweight.
  • Sufficient compliance.
  • No excessive consumption of alcohol or drug abuse.

A conservative therapy attempt is considered sufficient if the treatment concept has elements from the three key pillars: movement, nutrition and behavior. The therapeutic approaches from these sub-areas must be coordinated and carried out simultaneously. Medications can be used to support them.

Restrictive and malabsorptive procedures

Commonly used restrictive procedures include gastric banding (GB) and sleeve gastrectomy (SG) or tubular stomach. While the gastric band ties up the diameter in the upper part of the stomach, the tube stomach is formed by a left-lateral gastric resection. This not only reduces the size of the stomach, but also eliminates hormone-producing components that affect satiety.

The Roux-Y Gastric Bypass (LRYGB) is a more complex intervention, not only restrictive, but also malabsorptive. There remains a small gastric pouch, which is directly connected to the jejunum, the passage through the duodenum and large portions of the jejunum is switched off. Other malabsorptive procedures, such as bileopancreatic diversion (BPD), in which only about 100 cm of passage remain in the small intestine, as well as BPD with duodenal switch (DS), play hardly any quantitative role in Germany.

Choice of procedure

After the gastric bypass (RYGB) with 17 215 operations, the Sleeve gastrektomie (SG) with 15 795 documented procedures is the second most common procedure. It also shows the highest percentage increase over the entire period. Complex malabsorptive processes are currently playing a minor role in Germany. The implantation of a gastric band (GB) has been carried out since 2005 in 4 124 cases and is therefore in third place.

There was a significant decrease in gastric band implantation throughout the study. Patients with GB were significantly younger at 40.5 years than patients with all other procedures. In addition, they had a significantly lower BMI of 44.92 kg / m2.

Patients who underwent SG had a significantly higher BMI and a higher incidence of comorbidities compared to all other procedures. In particular, the frequency of cardiac comorbidities, are diabetes and sleep apnea.

The RYGB gastric bypass has been performed since 2005 in 17 215 patients. There was a clear preference for laparoscopic access, which accounted for 98.6% of interventions. Patients with RYGB (47.92 kg / m2) had a significantly lower BMI than patients with other procedures (50.27 kg / m2).

The more complex BPD (n = 148) was performed in 17 institutions participating in the study. The patients are older (43.4 vs. 42.7 years) and have a higher BMI (52.79 vs. 49.24 kg / m2) than patients with other procedures. The DS was conducted in 16 participating institutions as a one-time operation in 168 cases. Patients with duodenal switch are on average the oldest patients (46.7 versus 42.7 years) compared with other surgical procedures.

Between 2005 and 2014, 3 371 re and 2 039 re-do operations were undertaken. The percentage distribution of revision procedures on the surgical procedures was shown in the table. Most frequent were revisions to primary GB (44.7%) for late complications such as slipping, ligament defects, or esophageal motility disorders.

Restrictive procedure

Restriction means: Significantly less food can be consumed by reducing the size of the stomach. This causes weight loss. Typical restrictive procedures: gastric balloon, gastric band, tube stomach (or gastric sleeve).

The aim of these procedures is to reduce the amount of food that can be eaten at once. This way the patient starts feeling full faster and the sensation stays for a longer time. The classic example of such operation method is the Swedish adjustable gastric banding (SAGB).

Gastric banding

A minimally invasive operation (laparoscopy) is used to place an adjustable gastric banding around the upper part of the stomach. It can be filled from the outside through a port chamber with liquid thus narrowing it. Larger food portions can cause vomiting or esophagus stretching. If this happens too often, the banding becomes ineffective.

The gastric banding is a foreign body, but it is usually well tolerated. In principle, the banding can remain in the body for a lifetime – even when the desired weight has been reached. If it gets removed, the patient usually regains weight.

Restrictive procedures, such as the gastric banding, demand the collaboration and cooperation of the patient in order for the therapy to be successful.

Sleeve gastrectomy

In case of sleeve gastrectomy or left lateral stomach resection a large part of the stomach is surgically removed from the body. Thus, a gastric tube is formed which can hold much smaller amount of food than before.

Its function is primarily restrictive, similar to the gastric banding. However, an additional effect of the "sleeve" is that the part of the stomach is resected, which produces certain hormones responsible for the sensations of hunger and satiety. This includes, for example, the ghrelin.

Thus, the sleeve gastrectomy not only limits the amount of food the stomach can hold, it also changes the hunger, saturation and taste sensations, resulting in a reliable weight loss.

What is Metabolic Surgery?

Obesity is often associated with a number of metabolic disorders that form the so-called metabolic syndrome. These include severe metabolic disorders such as insulin resistance, dyslipidemia, type 2 diabetes mellitus and others. These diseases are also considered to be cardiovascular risk factors: they seem to favor the development of arteriosclerotic cardiovascular diseases directly. Myocardial infarction and cerebral infarction are the most unfavorable endpoints. In addition, dyslipidemia results in steatohepatitis (non-alcoholic fatty liver), a chronic liver disease that can dramatically convert to cirrhosis.

Metabolic surgery provides patients with excellent opportunities in achieving complete cure of type 2 diabetes mellitus, dyslipidemia and insulin resistance. The state of steatohepatitis can also be improved and cirrhosis averted.

Regarding diabetes mellitus type 2, insulin therapy after surgery is often superfluous, regardless of the amount of previously needed insulin. For example, a reduction of 300 IU insulin to zero is possible. The improvement in dyslipidemia usually occurs within a year after surgery, in parallel with weight loss.

Regarding the type of treatment, we offer a customized therapy with many options, from sleeve gastrectomy (gastric tube formation) to gastric bypass to biliopancreatic diversion with or without duodenal switch.

Malabsorptive procedure

These procedures are aimed to alter the digestive physiology in such a way that only part of the consumed food is absorbed by the body. This naturally reduces the amount of calories ingested. However, this procedure also has disadvantages: in the same way severe vitamin deficiency symptoms can occur as well as steatorrhea and extreme flatulence. The classical representative of such surgeries is the biliopancreatic diversion (BPD), which belongs to exceptional indications.

Gastric bypass

Gastric bypass is a classic example of the combined type of procedures. A small part of the stomach, a so-called pouch is surgically separated from the rest of the stomach, still remaining in the body. A part of the small intestine is anastomosed to the upper stomach, so that the duodenum and the proximal part of the jejunum are excluded from of the food passage and the alimentary limb is separated from the biliopancreatic limb.

Only much later in the Roux-en-Y jejunum anastomosis the digestive enzymes meet the food bolus. Only from here the digestion takes place as usual. Since the alimentary limb, i.e. the part through which the food gets transported without digestive enzymes, is approximately 150 cm long, the surgery was considered to cause a certain malabsorption. However, this fact is now disputed, at least with this length of the digestive limb.

After the operation

After a gastric bypass operation, the patients first feels no or much less hunger, the sense of taste and smell changes and they lose weight very rapidly. However, this cannot be explained by restriction or malabsorption alone. Surprisingly, the total energy consumption of the body increases after the operation despite significantly reduced calorie intake. In contrast, a diet with reduced energy consumption automatically lowers the basal metabolic rate, which makes further weight loss more difficult and when the diet is over leads to a rapid weight regain.

Diabetes mellitus is also dramatically affected. Probably due to the exclusion of duodenum and the early contact of food with the distal jejunum, there is a series of humoral changes that can break the extreme insulin resistance. Many patients who required high doses of insulin before the surgery are able to significantly reduce or even eliminate its intake altogether.

This effect is so great that it is now debated whether to operate patients with normal weight or only slightly obese diabetics if the diabetes can no longer be controlled in a conventional way. This metabolic surgery will probably prevail even more in the future, even if the mechanisms behind the effects are not fully understood at the moment.

Nowadays all bariatric surgeries can be carried out minimally invasive with tolerable risk, but they should be performed in an interdisciplinary centre in which all the disciplines involved in conservative therapy, diagnostics, preparation and implementation of the operation and, above all, the life-long aftercare of the patients work together. In order to prevent deficiency symptoms, patients must also take vitamins and micronutrients for their whole life after the gastric bypass operation, as they are absorbed in the proximal gastrointestinal tract. Diagnostics and treatment of other complications requires a lot of experience and expertise.

In 2009 the German Society for General and Surgery therefore drafted special guidelines, that allow clinics to get certified as obesity centres. In addition to certain infrastructural requirements, an obesity-experienced surgeon team and a minimum number of performed bariatric interventions are required.

Realistic expectations

Although these operations are very popular and the results in many cases is stunning, yet the gastric bypass and other obesity surgeries are not miracle remedies. If the doctors believe you are a good candidate for the procedure, they will surely explain to you that the operation alone does not guarantee that you will be able overcome obesity or maintain a healthy weight for a long time. In order to achieve tangible and lasting effects, it is necessary to maintain a strict dietary plan and do exercises. A scalpel can do nothing to improve your commitment and willpower.


The cost of stomach reduction varies greatly and depends, among other things, on the following factors:

  • Surgical technique and type of stomach reduction
  • Doctor and clinic
  • Location

Cost of a gastric balloon

The number of specialized obesity clinics in Germany is still relatively low, mostly private clinics offer the gastric balloon treatment for long-term weight loss.

The average cost is between €2,500 and €4,000.

This price usually includes:

  • Consultation, preliminary examination and nutritional advice
  • Insertion of the gastric balloon
  • Medical follow-up and removal of the gastric balloon after about 6 months

Cost of a gastric band

Significantly more expensive is the so-called gastric band. This surgical technique is much more complicated and involves a 2-3 day hospital stay. The cost of a gastric band is about €6,500-7,000.

Also included here:

  • Consultation and preliminary examination
  • Specialist surgery
  • Follow-up

Cost of a gastric bypass

Gastric bypass is a relatively costly measure compared to gastric balloon and gastric banding. In this operation, the stomach is surgically reduced and the food intake is throttled. The cost of a gastric bypass for self-payers are around €8,000–8,500.

Latest News in Bariatric Surgery

Practical tips for complaints after bariatric surgery


After obesity surgery, the gastrointestinal tract is often sensitive. Fortunately, simple dietary measures often help. An important part of long-term follow-up is the control of eating behavior and nutrition.

Bariatric surgery can do a lot of good in terms of weight loss and metabolic problems. However, such an intervention also requires a permanent and thorough change of eating habits - and adipose surgical candidates should be trained in advance.

It is advisable that the patients already know before the procedure about the postoperative diet (liquid phase, porridge phase, light diet), suitable portion sizes and healthy eating and drinking. Nevertheless, gastrointestinal complaints are common after bariatric surgery. What these are and what can be done about them, Dr. Tatjana Schütz from the University Medical Center Leipzig.

Nausea and vomiting occur in 30-60% of patients in the first postoperative months. Not infrequently this leads to dehydration. Causes are passage disturbances or an unadjusted eating behavior.

This helps: increase the fluid intake to at least 1.5 l per day and keep a drinking diary. Eat slowly, chew well, avoid strong smelling foods and pay attention to appropriate portion sizes. A thiamine deficiency can also lead to vomiting. Therefore, clarify this and if necessary supplement the vitamin.

Dysphagia (dysphagia, pressure and tightness after a quick meal) is mainly due to restrictive surgical procedures (for example, tubular stomach).

This helps: chew on enough (at least 15 times per bite) and eat slowly. Avoid dry, crumbly and fibrous foods (such as white bread, biscuits, beef). Prolonged dysphagia may require endoscopy.

Early dumping occurs about 30-60 minutes postprandially when the stomach empties quickly. It leads to the passage of intravascular fluid into the intestinal lumen, which can cause hypotension, tachycardia, flushing, nausea, pain and diarrhea.

This helps: Drink 30 minutes before eating to ensure a balanced hydration. Prefer complex carbohydrates, reduce refined carbohydrates. Increase protein and fiber in the diet. Use any viscosity-enhancing substances such as guar or pectin.

Late dumping is observed one to three hours postprandially and is associated with hypoglycemic symptoms (sweating, cravings, tremor, lack of concentration, somnolence).

This helps: take 10 g of sugar in the first postprandial hour.

Diarrhea and flatulence affect up to 40% of patients after bariatric surgery. It can lead to very frequent defecation and fatty stools.

This helps: reduce fat, fiber and possibly lactose (with secondary lactose intolerance), increase fluid intake and eat slowly. Avoid bloating foods such as cabbage, legumes and carbonated drinks, do without chewing gum (because a lot of air is swallowed). Use fennel, caraway and anise as tea or seasoning. If necessary, administer probiotics, loperamide, bile acid or pancreatic enzymes. Clarify if there is a bacterial overgrowth.

Constipation may develop with insufficient fluid intake or under the influence of certain supplements such as iron or calcium.

This helps: increase hydration (unsweetened drinks), increase dietary fiber (whole grains, fruits, vegetables). Crushed linseed, wheat bran or psyllium may make sense if you drink enough. Pay attention to regular exercise.

Food intolerances occur in some patients in the early postoperative period. Patients should be informed about this preoperatively.

This helps: eat small portions and chew thoroughly. The food that is currently not tolerated (for example, milk), leave out for a while and after some time check if the intolerance still exists.

Bariatrics and the desire to have children - is that right?


Obesity reduces fertility and, if the conception worked well, leads more often to pregnancy complications. Is a bariatric surgery the solution?

Many obese young women hope in vain for a spontaneous pregnancy. This is related to the fact that obesity is often associated with a hyperandrogenemia or polycystic ovarian syndrome (PCOS), said PD MD Christian Göbl, Medical University of Vienna. PCOS is often associated with increased insulin resistance and compensatory hyperinsulinaemia, which affect follicular growth and oocyte maturation, leading to decreased fertility.

Therefore, young, overweight women often need the help of reproductive medicine to fulfill their children's desire - and assisted reproductive technologies (ART) are much more likely to fail in the obese than in the lean. The higher the BMI, the greater the risk that ART will not lead to the desired baby.

Losing weight can help - that is why many obese women with an unfulfilled desire to have a baby choose a bariatric surgery. In fact, research shows that bariatric surgery can have a positive effect on hyperandrogenemia, and that up to 58% of women undergoing surgery experience spontaneous pregnancies after surgery.

But when is the right time for a pregnancy? After a gastric bypass surgery or after a sleeve gastrectomy (tube stomach), the woman should, if possible, pregnancy until one and a half years after the procedure plan, the speaker said. In the meantime, a safe contraceptive method should be chosen, but it should be noted that oral contraceptives may not be as reliable after the surgery (especially in the case of malabsorptive procedures) and that parenteral dosage forms may be safer.

Bariatric surgery affects the uptake of micronutrients and macronutrients, therefore women with children who have undergone an obesity surgery should be screened for deficiencies and substituted if necessary.

As further possible undesired effects of the operation, e.g. maternal anemia, an increased risk of intra-abdominal hernias, impaired glucose metabolism, and an increased risk of fetal growth restriction.

On the one hand, post-dumping hypoglycaemia may result in women giving birth to growth-retarded children more often after bariatric surgery. On the other hand, nutrient deficiencies of the mother, which also manifest on the unborn child, could be shown, as investigations of umbilical cord blood samples show.

To keep a close eye on fetal development, monthly ultrasound scans should be performed with a record of the unborn child's growth curve. Experts also recommend a connection to a perinatal center. If the child is born, the mother can be encouraged to breastfeed, with appropriate nutrient substitution during breastfeeding.

Bariatric Surgery Reduces Cancer Risk in Women


Stomach reduction and gastric bypass are not only the most effective and fast method to reduce the body weight for obese people. The treatment is also associated with a reduced risk of cancer in women. According to a publication in Gynecologic Oncology, first and foremost gynecological tumors could be avoided.

Obesity is an independent risk factor for a number of cancer types, including gynecological malignancies in breast, uterus, cervix and ovaries. Weight loss should therefore have a preventive effect against cancer. The most effective method of weight reduction is bariatric surgery, which limits food intake by reducing stomach size and / or reduces the absorption of nutrients in case of a gastric bypass.

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