Bariatric surgery

Abstract

Obesity is defined as a body mass index (BMI: weight in kilograms divided by height in meters squared)>30 kg/m2. Patients qualify for bariatric surgery with a BMI of 35 kg/m2 or greater with associated obesity-related comorbid conditions or with a BMI of 40 kg/m2 or greater. Obesity is associated with increasing rates of a large number of comorbid conditions including type 2 diabetes, obstructive sleep apnea, hypertension, as well as a variety of malignancies including breast, endometrial, and prostate cancer, among others. The current and most commonly used surgical techniques to treat morbid obesity includes procedures designed to restrict gastric capacity (restrictive procedures) such as sleeve gastrectomy and adjustable gastric banding and procedures that combine reducing gastric capacity to different degrees of diversion of food bolus contact with the duodenum and the small bowel (malabsorptive component), such as Roux-en-Y gastric bypass and biliopancreatic diversion with or without duodenal switch (BPD and BPD-DS). The introduction of laparoscopic techniques has led to appreciable decreases in perioperative morbidity while maintaining excellent long-term outcomes. Bariatric surgery provides major and sustained weight loss in most patients, while it improves, cures, or markedly lowers incidence rates of obesity-associated diseases and reduces overall mortality. This chapter describes in detail the two most common bariatric surgical techniques currently in use in the United States: the laparoscopic Roux-en-Y gastric bypass and the laparoscopic sleeve gastrectomy.