The role of surgery in obesity management.

Obesity is unique because of the multiplicity of severe complications and the obscure etiology of the disease. Surgical treatment of obesity is also unlike most other surgery. It is neither pathology-oriented nor symptomatic: since the etiology of obesity is not known, the surgery can not have curative intent. Anti-obesity surgery is not a technical exercise, though technique is important, but rather should be seen as a behavioral intervention, requiring extensive preoperative education and life-long follow-up.The risks of most anti-obesity surgery have been reduced to levels significantly below the risk of severe obesity itself. Reduction of comorbidity and improvement in quality-of-life justify this treatment modality which is much more effective than all non-surgical methods in maintaining medically significant weight loss. Recent developments of minimally invasive techniques, with higher margins of safety and less discomfort, should increase the role of surgery in secondary prevention through earlier intervention.