REVIEW   

Minerva Chirurgica 2018 February;73(1):41-54

DOI: 10.23736/S0026-4733.17.07588-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Surgical management of obesity

Samuel TORRES-LANDA ¹, Umashankkar KANNAN ², Isabella GUAJARDO ³, Octavia E. PICKETT-BLAKELY ⁴, Daniel T. DEMPSEY ¹, Noel N. WILLIAMS ¹, Kristoffel R. DUMON ¹ ✉

¹ Department of Surgery, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA; ² Department of Surgery, Bronx-Lebanon Hospital Center, New York, NY, USA; ³ Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA; ⁴ Department of Medicine, Perelman School of Medicine Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA

Obesity is a spreading epidemic associated with significant morbidity and mortality with a prevalence of over 36% worldwide. In the face of a growing epidemic, increasing medical costs, and the disappointing limitations of medical and lifestyle modification bariatric surgery was found to consistently lead to significant weight loss and improvement in obesity-associated comorbidities when compared to non-surgical interventions. Bariatric procedures fall within three basic categories: restrictive procedures, malabsorptive procedures, and procedures that combine both restrictive and malabsorptive mechanisms. Four major procedures are currently performed (most often laparoscopically): Roux-en-Y gastric bypass, biliopancreatic diversion with duodenal switch, adjustable gastric banding, and sleeve gastrectomy. Although the laparoscopic Roux-en-Y gastric bypass was the most frequently performed bariatric procedure, the laparoscopic sleeve gastrectomy has since become the most popular. Bariatric surgery currently has similar mortality rates to standard general surgical operations. Morevoer, bariatric surgery reduces mortality by the improvement and remission of obesity-related comorbidities. Newer minimally-invasive weight loss procedures and endoscopic methods continue to evolve as we expand our understanding of the intricacies of obesity and the effects of currently available surgical treatments.

KEY WORDS: Bariatric surgery - Weight loss - Obesity