Surgical treatment for morbid obesity

Abstract

Since severe obesity is frequently associated with serious metabolic, cardiovascular and psychological co-morbid conditions, and given the usually unsuccessful results of conservative therapeutic approaches, surgical treatment based on gastric restriction procedures is increasingly recognized as a treatment of choice for morbidly obese persons. Among several surgical approaches designed to promote a substantial loss of weight, two gastric restriction procedures, i.e. the vertical banded gastroplasty and the gastric bypass, have been increasingly used during the past years. Both techniques induce an impressive loss of weight, and are surprisingly well tolerated, even by severely obese persons.The usual 50-75% reduction of initial weight excess, is followed by a clear-cut reduction, or even disappearance of, obesity-related co-morbidity, such as hypertension, diabetes mellitus or sleep apnea syndrome.While serious peri-and postoperative risks are very limited, the intractable vomiting occurring after gastroplasty, and potential sequelae related to iron and calcium malabsorption after the gastric bypass, represent much more frequent complications of the surgical treatment of obesity. There is also a tendency towards a late regain of weight, but the benefit in terms of improvement in the obesity-associated co-morbidity is in general maintained despite this partial increase in weight.Gastric procedures are, therefore, an effective treatment of severe obesity and of its co-morbid conditions. However, careful medical and nutritional supervision is necessary during the follow-up after surgery, to prevent potential nutritional or digestive complications.

Preoperative Very Low-Calorie Diet and Operative Outcome After Laparoscopic Gastric Bypass

“…In contrast, surgical intervention for severe obesity has been demonstrated to result in long-lasting effects on not only weight but also obesityassociated disease. [1][2][3][4] Therefore, the number of bariatric surgical procedures is increasing rapidly and has become one of the most commonly performed surgical procedures worldwide. 5 Today, most bariatric surgical procedures are performed laparoscopically.…”

Obesity: from molecules to man

“…Successful treatment must encompass both a period of acute weight loss and a sustained period of weightloss maintenance. Weight loss can be achieved using a variety of strategies, including dietary restriction, low-fat diets (Astrup et al 1997), very-low-energy formula diets ' ' 1 M e n Women 1980 1987 1994 " 1980 1987 1994 Year of survey (Jebb & Goldberg, 1998), pharmacotherapy (Finer, 1997), or surgery (Kolanowski, 1997). Weight losses of 10 % or greater are relatively common, but most interventions ultimately fail because weight loss is quickly followed by regain.…”

Cirurgia bariátrica cura síndrome metabólica?

“…Analisamos também a evolução da leucometria como marcadora do estado inflamatório crônico subclínico (6,7,(20)(21)(22)(23) nas pacientes estudadas. (25). O diagnóstico pré-operatório de SM foi firmado com base nos critérios do NCEP-ATP III, que considera como portadores da SM indivíduos que apresentem pelo menos três dos cinco critérios descritos na tabela 1 (8).…”