Bariatric surgery and surgical devices in obesity management

Abstract

Obesity levels worldwide are reaching epidemic proportions with resultant strain on healthcare systems and individual wellbeing. To date, bariatric surgery is the management option that produces the greatest degree of weight loss which can be maintained in the long term along with a reduction in obesity-associated comorbidities such as diabetes and fewer cardiovascular events. Roux-en-Y gastric bypass, laparascopic gastric band and sleeve gastrectomy are the most widely performed bariatric procedures but, despite low perioperative mortality and complication rates, these procedures may not be suitable for all patients due to other factors. Newer surgical techniques are being developed both laparoscopically and endoscopically, in addition to the use of less invasive non-surgical devices that can achieve weight loss, by (1) increasing satiety such as gastric pacing and vagal nerve inhibition and (2) reducing absorption through aspiration of gastric contents, duodenal sheaths and thermal ablation of the duodenal mucosa. This article reviews current and future bariatric surgical procedures and introduces non-surgical devices that may increasingly feature in the management of obesity.