Bariatric surgery

Bariatric surgery today is the only effective therapy for morbid obesity. Commonly performed procedures include adjustable gastric banding (AGB) and vertical banded gastroplasty (VBG); variations of Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion or duodenal switch (BPD) and mixed procedures. All these procedures can be performed by open surgery and more recently by laparoscopy. This review discusses key issues in the surgical management of morbid obesity.

The two most common bariatric procedures performed worldwide are laparoscopic AGB and laparoscopic RYGB. Controversy exists regarding the best surgical procedure. For example, gastric bypass is the procedure of choice in the United States, while most surgeons in Europe and Australia favor gastric banding. Weight loss decreased according to the procedures performed in following decreasing order: BPD, RYGB, VBG, AGB.

Concerning the complications and quality of life there is no single operation for morbid obesity without drawbacks. According the currently opinion are gastric restrictive procedures (AGB, VBG) generally considered safe and quick to perform, but the long-term outcome and quality of life, especially with regard to eating patterns, have been questioned. On the other hand the long-term efficacy of AGB can be improved by the development of new band devices. More complex bariatric procedures, such as RYGB or BPD, have a greater potential for serious perioperative complications but are associated with good long-term outcome in terms of weight loss combined with less dietary restriction.