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1. Surgical therapy is the only effective and proven therapy for patients with severe obesity (body mass index of ⩾35 kg/m2). Bariatric operations prolong survival and resolve comorbid medical conditions associated with severe obesity.

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2. Bariatric surgery is also metabolic surgery, treating the varied metabolic consequences of the comorbid diseases arising from severe obesity. Some operations are particularly effective treatments for such metabolic consequences, such as gastric bypass for type 2 diabetes.

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3. Bariatric operations involve either restriction of caloric intake or malabsorption of nutrients, or both. Long-term follow-up is essential before the merits of an operation can be confirmed.

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4. During the years 1999 to 2003, here called the bariatric revolution, the availability of a laparoscopic approach for bariatric operations caused major changes in the field, including a major increase in the number of procedures performed as well as an increased public and professional awareness and understanding of the field.

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5. Laparoscopic gastric bypass is the most common procedure in the United States. The laparoscopic adjustable gastric band procedure is the most popular procedure performed outside the United States and is increasing in popularity in the United States.

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6. Patients who develop a bowel obstruction after laparoscopic gastric bypass require surgical and not conservative therapy due to the high incidence of internal hernias and the potential for bowel infarction.

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7. Malabsorptive operations are highly effective in producing durable weight loss but have considerable nutritional side effects. Patients undergoing such procedures require close follow-up and must take appropriate nutritional supplements.

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8. All bariatric operations are tools that serve to allow the patient to lose weight, become healthier, and improve quality of life. These changes are maintained long term especially if the patient permanently adopts the new eating patterns and exercise habits that are taught and expected in the early year(s) after surgery.

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The focus of this chapter is the surgical treatment of obesity. Bariatric surgery has been a dynamic surgical field, and changes have continued in recent years. The most substantial change is now the focus within the field on the recognized ability of surgical therapy to treat the metabolic consequences of obesity and not just obesity itself. Although the goal of bariatric surgery has always been to improve the medical condition of all patients for whom it is performed, a major emphasis is now being placed on the fact that resolution of the metabolic conditions that in severe obesity cause a variety of medical problems is as important as the actual amount of weight lost. This emphasis has been publicly recognized by the renaming of the professional society in the United States focusing on the surgical treatment of obesity from the American Society for Bariatric Surgery to the American Society for Metabolic and Bariatric Surgery.

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Other major changes in the field of bariatric surgery in the United ...

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