[Surgery for pathological obesity]

Morbid obesity is defined by a body mass index greater than 40 kg/m2 and constitutes a real disease, which shortens the patient's life expectancy, especially as a result of multiple metabolic, endocrine or respiratory complications. Since it has been demonstrated that these complications are improved by weight loss and as diets very often fail, surgical treatment has been proposed to these patients. Techniques have advanced since the 1960s: intestinal bypasses have been abandoned because of complications related to malabsorption. Biliopancreatic or gastric bypasses may be proposed to extremely obese patients, but most patients can benefit from vertical or inflatable ring gastroplasty, which is adjustable and reversible. It can be performed by laparoscopy which limits postoperative complications and the incisional hernias classically observed after laparotomy. This treatment can only be considered in the context of a multidisciplinary team composed of an endocrinologist, psychologist and dietician to ensure good selection and attentive follow-up of patients.