Operations for Morbid Obesity

Abstract

The prevalence of obesity has increased dramatically over the past several decades worldwide and is currently reaching epidemic proportions. In the United States, two thirds of individuals are considered overweight. One in five Americans is currently obese. Morbid obesity, defined as body mass index (BMI) > 40 kg/m² or BMI > 35 kg/m² with weight-related morbidity, is associated with many diseases responsible for a high prevalence of morbidity and mortality, such as insulin-resistant diabetes mellitus, hypertension, coronary artery disease, hyperlipidemia, and sleep apnea. These direct weight-related complications eventuate in enormous health care costs.

The only evidence-based approach to substantial and sustainable weight loss in patients with severe obesity is bariatric surgery.

Current bariatric surgical procedures are divided into restrictive, malabsorptive, and combined procedures.

• Restrictive procedures aim to decrease the volume of oral intake. These include laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (SG), and vertical banded gastroplasty (VBG).

• Malabsorptive procedures are designed to decrease protein and caloric absorption by diminishing the absorptive surface for digestion and/or absorption. The most common procedures currently are biliopancreatic diversion (BPD) and duodenal switch with a biliopancreatic diversion (BPD/DS).

• Combined procedures utilize both a restrictive and a selective malabsorptive anatomy and involve primarily the Roux-en-Y gastric bypass (RYGB) (the malabsorptive effect correlates with length of Roux limb).