Principles and results of bariatric surgery

Bariatric surgery is followed by substantial and durable weight loss and associated with it favorable metabolic effects far beyond those achieved by lifestyle modifications and pharmacological treatments. The perioperative and postoperative morbidity and mortality have decreased significantly over the years to the level that bariatric surgery now can compare with other frequently recommended and well-accepted procedures such as cholecystectomy and hysterectomy. In fact, the postoperative mortality risk of bariatric surgery is far lower than that of coronary artery bypass surgery but with significantly greater improvement in long-term mortality. Much of the improvement in perioperative morbidity and mortality can be attributed to advances in many components of the care chain such as the introduction of laparoscopic surgery, as well as establishment of a nationwide center of excellence network and required outcome reporting. Extensive evidence on safety and efficacy supports bariatric surgery as the standard of care for treatment of severe obesity. Bariatric surgery reduces the risk of global mortality, all-cause mortality and cardiovascular mortality when compared to obese control patients. Both gastric banding and gastric bypass seem to reduce mortality risk.