RT Book, Section A1 Courcoulas, Anita P. A1 Schauer, Philip R. A2 Brunicardi, F. Charles A2 Andersen, Dana K. A2 Billiar, Timothy R. A2 Dunn, David L. A2 Kao, Lillian S. A2 Hunter, John G. A2 Matthews, Jeffrey B. A2 Pollock, Raphael E. SR Print(0) ID 1164317138 T1 The Surgical Management of Obesity T2 Schwartz's Principles of Surgery, 11e YR 2019 FD 2019 PB McGraw-Hill Education PP New York, NY SN 9781259835353 LK accesssurgery.mhmedical.com/content.aspx?aid=1164317138 RD 2024/10/05 AB Key Points Sixty-five percent of the world’s population live in countries where overweight and obesity are linked to more deaths than underweight and malnutrition. Obesity is the second leading cause of preventable death in adults in the United States. There is an ongoing major shift in procedure utilization with the sleeve gastrectomy and Roux-en-Y gastric bypass being the two most common procedures, worldwide. The former classification of bariatric operations as either “restrictive” or “malabsorptive” is being replaced by knowledge from investigation into the more basic physiologic and metabolic mechanisms responsible for the effects of bariatric surgery. 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. Malabsorptive operations are highly effective in producing durable weight loss and metabolic improvements but have higher surgical complication rates and considerable nutritional side effects. Patients undergoing such procedures require complete follow-up and appropriate nutritional supplements. Large, longer-term observational studies of bariatric surgery have shown durable weight loss, diabetes remission, lipid improvements, and improved survival with bariatric surgery. Still unclear are specific pre- and postoperative predictors of those outcomes, long-term complications, microvascular and macrovascular events, mental health outcomes, and costs. High quality data have clearly established that bariatric procedures are more effective than medical or lifestyle interventions for inducing weight loss and initial remission of type 2 diabetes, even in less obese patients. Randomized clinical trials showed greater weight loss and type 2 diabetes mellitus remission following bariatric surgery compared with nonsurgical treatments. The incidence of complications after bariatric surgery varies from 4% to over 25% and depends on the duration of follow-up, the definition of complication used, the type of bariatric procedure performed, and individual patient characteristics. Emerging areas in bariatric surgery include the use of intermediate weight loss devices, adolescent bariatric surgery, and the increase in the need for revision and conversion bariatric procedures.