Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes

Abstract

Obesity is recognized as a global health crisis. Bariatric surgery offers a treatment that can reduce weight, induce remission of obesity-related diseases, and improve the quality of life. In this article, we outline the different options in bariatric surgery and summarize the recommendations for selecting and assessing potential candidates before proceeding to surgery. We present current data on post-surgical outcomes and evaluate the psychosocial and economic effects of bariatric surgery. Finally, we evaluate the complication rates and present recommendations for post-operative care.

Figure 1

RYGB: Roux-en-Y gastric bypass. An upper gastric pouch, of 15 to 30 mL in volume, and a lower gastric remnant is formed from the stomach. The jejunum is divided some 30 to 75 cm distal to the ligament of Treitz, and anastomosed to the gastric pouch. The distal jejunum is brought up as a 'Roux-limb'. The excluded biliary limb, including the gastric remnant, is anastomosed to the bowel some 75 to 150 cm distal to the gastrojejunostomy. The included figures are the property of Johnson and Johnson and Ethicon Endo-Surgery (Europe). They are reproduced here with their kind permission.

Figure 2

AGB: Adjustable gastric band. A band with an inner inflatable silastic balloon is placed around the proximal stomach just below the gastroesophageal junction. The band is adjusted through a subcutaneous access port by the injection or withdrawal of solution. The included figures are the property of Johnson and Johnson and Ethicon Endo-Surgery (Europe). They are reproduced here with their kind permission.

Figure 3

SG: Sleeve gastrectomy. The stomach is transected vertically creating a gastric tube and leaving a pouch of 100 to 200 mL. The included figures are the property of Johnson and Johnson and Ethicon Endo-Surgery (Europe). They are reproduced here with their kind permission.

Figure 4

BPD: Biliopancreatic diversion. A 400 mL gastric pouch is formed from the stomach. The small bowel is divided 250 cm proximal to the ileocecal valve and is connected to the gastric pouch to create a Roux-en-Y gastroenterostomy. An anastomosis is performed between the excluded biliopancreatic limb and the alimentary limb 50 cm proximal to the ileocecal valve. In BPD-DS, a vertical sleeve gastrectomy is constructed and the division of the duodenum is performed immediately beyond the pylorus. The alimentary limb is connected to the duodenum, whereas the iliopancreatic limb is anastomosed to the ileum 75 cm proximal to the ileocecal valve. The included figures are the property of Johnson and Johnson and Ethicon Endo-Surgery (Europe). They are reproduced here with their kind permission.