Laparoscopy for primary and secondary bariatric procedures

Recently obesity has been defined as a disease and has turned bariatric surgery into a part of a chronic illness management. Obesity induces several comorbidities leading to cardiovascular disease and mortality. The effects of bariatric surgery on these comorbidities used to be classified as weight-loss induced. However bariatric surgery has recently been termed metabolic surgery because of the suspected direct, weight loss independent effect of bariatric procedures on the physiopathological mechanisms causing excess fat storage and insulin resistance. This review describes the standard procedures commonly performed and their specific outcomes on metabolic diseases in order to work towards more patient tailored treatment of obesity and to reduce side effects. Furthermore this review focuses on gaps in understanding the pathogenesis of obesity and its treatment with bariatric surgery. Surgery failures as well as new techniques are discussed and evaluated.