Obesity surgery in perspective.

Increasing numbers of physicians are discontinuing the use of jejunoileal (JI) bypass as a surgical solution to morbid obesity in favor of gastric restriction procedures. However, there is a significant risk that, as with JI bypass several years ago, gastric bypass (or its variations) may be regarded shortly by many as a panacea without sufficient evidence to support this belief. Current evidence suggests that gastric restriction procedures are followed by weight loss similar to that seen with JI bypass, without the high incidence of complications, rehospitalization, reanastomosis, or conversion to another operation for further weight reduction. However, long-term prospective studies which demonstrate permanence of weight loss and absence of late complications of the gastric restriction procedures as yet are unavailable. Therefore, gastric bypass, gastroplasty, and the other variations of gastric restriction should be carried out only in a setting where long-term follow-up (by an experienced multispecialty team) and complete postoperative testing with statistical evaluation are available.