The Development of the Surgical Treatment of Morbid Obesity

Abstract

Morbid obesity is defined as obesity with a body mass index ≥40, or ≥35 with secondary serious diseases. Conservative medical therapies in these individuals generally fail to sustain weight loss. Thus, surgical operations have evolved which are based on gastric restriction and/or malabsorption. Historically, the intestinal bypass operation was followed by the gastric bypass operation (in some instances combined with intestinal bypass) or by the gastric restriction operations (gastroplasty or gastric banding). Laparoscopic techniques are now being used for these operations, but require surgical expertise in both the bariatric operations and advanced laparoscopic skills. All operations may have complications, but these occur in a very small percent. Postoperative follow-up and nutritional surveillance are mandatory. The operations result in significant weight loss, and the current operations have a mean lasting weight loss of about 50 percent of excess body weight, with improvement or resolution of most obesity-associated conditions. There is evidence that even modest to moderate weight loss in these individuals has significant medical benefit.

• morbid obesity
• bariatric surgery
• intestinal bypass
• gastroplasty
• gastric bypass
• gastric banding
• surgical technique
• laparoscopy

Key teaching points:

• Morbid obesity results in progressive serious medical diseases.

• This obesity has been found to be refractory to conservative therapies.

• Effective operations which sustain significant weight loss (i.e., loss of 40% to 80% of excess weight) have developed.

• These operations depend on gastric restriction and/or intestinal bypass (malabsorption).

• The postoperative complication rates are low, and the sequelae of massive obesity reverse as the weight loss occurs.

Key teaching points:

• Morbid obesity results in progressive serious medical diseases.

• This obesity has been found to be refractory to conservative therapies.

• Effective operations which sustain significant weight loss (i.e., loss of 40% to 80% of excess weight) have developed.

• These operations depend on gastric restriction and/or intestinal bypass (malabsorption).

• The postoperative complication rates are low, and the sequelae of massive obesity reverse as the weight loss occurs.

The authors are grateful to Agnieszka Mroszczyk, BA, for secretarial assistance and Ruth Bandong, BSc, for the artwork.