[New directions in bariatric and metabolic surgery]

Czech Republic may be counted among the leading European Countries in regards of the level of delivered high quality multidisciplinary care in treatment of obesity and obesity related metabolic diseases. The 1st Faculty of Medicine (Charles University) and the Faculty General Hospital in Prague played the most important role in the development of bariatric and metabolic surgery in the Czech Republic. pCzech bariatric surgery achieves great successes both on national and international levels. Just to mention some of them: M. Fried and M. Pešková were among the very first worldwide to implant the non-adjustable gastric banding laparoscopically in 1993, the Czech Republic was among the seven Countries to establish the International Federation for the Surgery of Obesity /IFSO/ (Fried in 1995), to organize the first IFSO World Congress in Prague (1996), to co-establish the IFSO-European Chapter in Prague (2004), to implant the first SAGB VC worldwide (Fried, Doležalová, 2007), to organize the first European Workshop on Gastric Plication (Fried, Doležalová, 2010), to co-lead development of the European Interdisciplinary Guidelines on Metabolic and Bariatric Surgery (Fried et al.,2013), and many others. In the beginning of bariatric surgery, the almost only indication criterion for operation was the criterion of weight loss. On the turn of the Century metabolic surgery gradually gained importance. The most important indication criterion for metabolic operations started to be improvement and/or resolution of obesity related co-morbidities, such as type 2 diabetes mellitus. Thus, the criterion of successful treatment shifted from weight loss towards improvement and resolution of metabolic diseases regardless the body mass index. In conjunction with importance of metabolic surgery, more emphasis is given to lowering the invasiveness of so far available minimally invasive/laparoscopic approaches form the perioperative perspective as well as from the anatomically sparing/reversible surgeries.