Laparoscopic bariatric surgery

Abstract

Laparoscopy has meant profound changes for the field of bariatric surgery. Bariatric operations, which are technically difficult because of the patient population, were not performed laparoscopically until the last 5 years of the 20th century. The years 1998 to 2003, herein defined as the Bariatric Revolution, saw profound changes in the way bariartric surgery was practiced. Major changes in patient education, public awareness, patient enthusiasm, popularity of the surgery, and academic acceptance of bariatric surgery occurred during this time. This led to such a massive increase in procedures performed that there was a reactionary movement by insurers to deny coverage for these procedures. Limitation of access to care and other important socioeconomic issues are now being debated and confronted in the bariatric arena. Recommendations for the field are suggested. The outcomes of these controversies will potentially have a profound impact on all of surgery.

Non‐alcoholic fatty liver disease: Further expression of the metabolic syndrome

“…Recent data suggest a role for orlistat, a lipase inhibitor, as an adjunct to weight loss 72,73 . Several studies have reported beneficial effects of bariatric surgery, 74–76 although precipitous weight loss has the potential to exacerbate steatohepatitis. Pretreatment with cytoprotective or anti‐oxidant agents in this setting has not been tested.…”

“…Recent data suggest a role for orlistat, a lipase inhibitor, as an adjunct to weight loss. 72,73 Several studies have reported beneficial effects of bariatric surgery, [74][75][76] although precipitous weight loss has the potential to exacerbate steatohepatitis. Pretreatment with cytoprotective or anti-oxidant 64 Lipomatosis Lipoatrophy/lipodystrophy (possibly missed in its focal or partial form) Panniculitis (feature of Weber-Christian) Neurologic deficits (ocular muscle palsy and deafness as part of maternally inherited DM) Palmar erythema, spider angiomata, and splenomegaly (cryptogenic cirrhosis) Mild elevation of AST/ALT levels (<1.5¥ the upper normal level) AST > ALT (altered with antidiabetic therapy) g-glutamyltransferase and alkaline phosphatase level elevation Hyperglycemia (DM is present in approximately one-third of patients) Hyperlipidemia (usually triglycerides) in approximately 20-25% Serum IgA level is elevated in approximately 25% of NASH patients Antinuclear antibody in approximately one-third of patients Abnormal iron indices US, CT, or MR imaging: insensitive to degrees of steatosis <25-30%.…”

Weight loss and eating behavior following vertical banded gastroplasty

“…Surgical treatment is the only intervention resulting in long-term weight reduction;6 as a consequence, the number of operations performed has more than doubled within a few years 7. Bariatric surgery not only leads to substantial weight reduction, but also to improvement or cure of co-morbidities, including diminishing of psychopathology and abnormal eating behavior 5.…”

Review of Various Aspects of Laparoscopic Roux-en-Y Gastric Bypass to Emphasize its Significance in Bariatric Surgery

“…13 In one another study, LAGB is found significantly associated with more late complications, reoperations, less weight loss, less reduction of medical comorbidity and patient dissatisfaction compared with LRYGB. 14 The following table shows the outcome of different types of bariatric operations (Table 1). 15…”