Open-surgery management of morbid obesity: old experience-new techniques

Bariatric surgery is well established to treat morbidly obese patients (BMI >40 kg/m(2)) with various techniques. Gastric-restriction procedures [adjustable gastric band, vertical banded gastroplasty (VBG)] reduce caloric intake and are well accepted (weight loss up to BMI 28-33 kg/m(2) after 5 years), but they are less effective in super-obese patients and in sweet-eaters. For that group combined techniques, such as duodenal switch, gastric bypass or bilio-pancreatic diversion, could produce a better weight loss (between 60 and 160 kg or BMI of 25-30 kg/m(2)) with acceptable long-term side effect; however, due to malabsorption, a lack of minerals and vitamins, even protein, could occur and have dangerous side effects. Both basic techniques have their place in the treatment of morbid obesity. The surgical approach-open or mini-invasive-is only of minor importance. Technical complications should be avoided, especially band dislocation (2-12%) or suture leak. Long-term follow-up is very important because obesity is a chronic disease with a high risk of recurrence, even after bariatric surgery.