Bariatric surgery for morbid obesity: pre-operative assessment, surgical techniques and post-operative monitoring

This observational clinical analysis included 246 patients who underwent surgery for adjustable gastric banding (AGB), laparoscopic sleeve gastrectomy (LSG), or gastric bypass (GBP) between May 2005 and December 2008. The most frequent surgical procedure was for AGB (73.2% of patients). A thorough psychological evaluation of the patients was carried out, and pre- and post-operative psychological and dietary support was offered. A total of 111/120 (92.5%) AGB patients, 21/30 (70.0%) LSG patients and 8/36 (22.2%) GBP patients have been monitored for at least 1 year, and their mean weight losses (percentage excess weight loss) were 24.7 kg (52.4%), 46.0 kg (57.9%) and 40.5 kg (77.9%), respectively. The AGB procedure was associated with the fewest complications but is not appropriate for all patients. Good pre-operative psychological evaluation has been shown to be necessary for successful outcomes and, in the super-obese, we prefer to use LSG. Surgeons should learn the skills needed to perform laparoscopic Roux-en-Y GBP as it is likely to become the standard-of-care for the surgical treatment of obesity. The best outcomes following bariatric surgery are achieved with a multidisciplinary approach, including participation in a support group guided by a psychologist.