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