[Principles of surgical treatment of morbid obesity]

The incidence of morbid obesity has steadily increased over the last few years. Although conservative treatment of morbidly obese patients made some progress (e.g. Xenical), a persistent weight reduction can hardly be achieved in these patients. The possibility of a minimal invasive approach lead to a revival of the surgical therapy of morbid adiposity. The laparoscopic gastric banding became an attractive therapy for patients presenting with a body mass index greater than 40 kg/m2. However, the long-term follow-up after laparoscopic gastric banding increasingly shows the limit of this surgical approach and emphasises the importance of a determined preoperative patient selection. This article reviews the clinical basics and functional mechanisms of different surgical methods to treat morbid obesity comparing their advantages and disadvantages. Due to the widely and nowadays very popular application of laparoscopic gastric banding, this operative method is described in detail.