Operations that are Questionable for Control of Obesity.

At the last review of the literature, there were 43 different operations or modifications thereof used for the control of obesity. An effective operation for obesity control should produce a significant weight loss (>/= 25% excess weight loss) to ameliorate the associated medico-sociopsycho-economic ramifications of the obesity. The operative and postoperative significant morbidity should be less than 20% and mortality less than 1%. The weight lost should be maintained for a long period (>/= 5 years). The effects of the operation should be reproducible and documentable by more than two authors working independently. For the purpose of this paper, operations which do not meet these criteria are considered questionable and not recommended for general use. Based on these criteria, questionable operations for treatment of obesity include: tooth wiring, acupuncture, hypothalamic center manipulation, liposuction, balloon insertion, unbanded gastric partitioning, vagotomy, gastrogastrostomy, horizontal gastroplasty, gastric wrap, gastroclip, and any variety of gastroplasty without a reinforced stoma, intestinal bypass, duodenal bypass and biliointestinal bypass. Data to substantiate this classification will be presented and discussed. Since the surgical treatment of obesity is evolving, there is need to collect data from and make modifications to improve the effects of all operations. There is not enough data at this time to prohibit the use of any operation, but the data presented will justify limiting the use of certain operations to institutions dedicated to meticulous follow-up and research.