Surgical approach to the obese patient

Morbid obesity is a life-threatening disorder associated with medical and psychological complications. The failure of medical therapy has led to the development of a new surgical discipline called bariatric surgery, which has evolved over the past three decades. Initial techniques created malabsorption to produce weight loss. Due to complications, later techniques limited oral intake to produce weight loss. Currently, most bariatric surgeons perform either gastric bypass or gastric partition (vertical banded gastroplasty or vertical ring gastroplasty). However, other techniques are also being evaluated, including a modified intestinal bypass, gastric banding, and a new gastric balloon. Only with continued follow-up will we determine the ultimate risk/benefit ratio of these procedures and their place in the management of the morbidly obese. In the setting of an experienced multidisciplinary team committed to long-term follow-up, surgical therapy can be considered.