Obesity: surgical options.

Conservative treatment has been shown in long-term studies to be ineffective in morbid obesity. Surgical treatments break down into restrictive, malabsorptive, combined restrictive and malabsorptive or motility-reducing procedures. Laparascopic implantation of an adjustable gastric band is an efficient restrictive measure for treating the majority of patients with this condition. The adjustable gastric band enables weight loss and food intake to be adapted to the individual patient's need. Eighty percent to 90% of these patients can expect to lose 55-70% of their excess weight. Vertical banded gastroplasty is losing ground among the restrictive options. Preliminary experiences are encouraging but the long term results are disappointing when assessed by the standard criteria. Gastric bypass is gaining ground in Europe and a standard procedure in USA. This operation is estimated to give 70-80% excess weight loss and provide better quality of life than restrictive procedures. The biliopancreatic diversion with duodenal switch combines a sleeve gastrectomy with a duodenoileal switch to achieve maximum weight loss. Consistent excess weight loss between 70 and 80% is achieved with acceptable decreased long-term nutritional complications. The laparoscopic approach to this procedure has successfully created a surgical technique with optimum benefit and minimal morbidity, especially in the super obese patient. Intra-gastric stimulation is the least invasive surgical procedure at present. However, the excess weight loss is lowest with this method at only 32% in the first 2 years after the operation. Provided safety recommendations are observed, laparoscopic operations for obesity are fairly low-risk. The mortality rate in centres with experienced staff is less than 0.3%. Surgical treatment for obesity has proved that it is the best and most effective means of preventing the life-threatening complications and serious degenerative problems associated with morbid obesity. There is no one operation that is effective for all patients.