Obesity is a major worldwide problem in public health, reaching epidemic proportions in many countries, especially in urbanized regions. Bariatric procedures have been shown to be more effective in the management of morbid obesity, compared to medical treatments in terms of weight loss and its sustainability. The two most commonly performed procedures are laparoscopic Roux-en-Y gastric bypass (LRYGB), laparoscopic adjustable gastric banding (LAGB), and the novel laparoscopic sleeve gastrectomy (LSG). The MEDLINE database (cutoff date September 2010), LILACS, and the Cochrane Library were searched using the key words "gastric bypass," "sleeve gastrectomy," and "gastric banding." Only studies that compared at least two of the laparoscopic procedures were included. Reviews and meta-analysis, editorial letters or comments, case reports, animal or in vitro studies, comparisons with medical treatment, comparisons with open (non-laparoscopic) procedures were excluded. Most studies indicated that LRYGB and LSG could be more effective achieving weight loss than LAGB. However, LAGB seems to be a safer procedure with frequent, but less severe, long-term complications. Although not uniformly reported, a resolution of obesity-related comorbidities was achieved with most bariatric procedures. The three procedures have acceptable efficacy and safety. We believe that patients should be informed in detail on the advantages and disadvantages of each available procedure, possibly in several interviews and always accompanied by a specialized interdisciplinary team, warranting long-term follow-up.

This review demonstrates that the laparoscopic Whipple procedure is not only feasible but also safe, with low mortality and acceptable rates of complications.

IntroductionGastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the late ones.MethodLiterature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English.ResultsThere were selected 35 studies that matched the headings. Late complications were considered as: anastomotic strictures, marginal ulceration and gastrogastric fistula.ConclusionKnowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.

IntroductionGastric bypass is today the most frequently performed bariatric procedure,but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the early ones.MethodLiterature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English.ResultsThere were selected 26 studies that matched the headings. Early complications included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal obstruction and incorrect Roux limb reconstruction.ConclusionsKnowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.