Bariatric surgery: past and present.

Bariatric operations are either restrictive, limiting the amount of food ingested; malabsorptive, limiting the amount of nutrient absorbed; or a combination of both. Bariatric surgery dates back to the 1950s when jejunoileal bypass was introduced. Since then, numerous improvements have been made in procedures and techniques. Currently, the two most common bariatric procedures performed are laparoscopic adjustable gastric banding and laparoscopic Roux-en-Y gastric bypass. Both of these operations provide excellent results, with the majority of patients losing more than 50% of their excess weight and with most obesity-related comorbidities such as diabetes and hypertension reversed or prevented. Morbidly obese patients considering such operations have to meet strict criteria and must be evaluated by a multidisciplinary team. They need to commit to long-term dietary changes, behavioral modifications, and medical supervision. The choice of procedure is guided by multiple factors, including the patient's and the surgeon's preference.