Development of minimally invasive techniques for management of medically-complicated obesity

Abstract

The field of bariatric surgery has been rapidly growing and evolving over the past several decades. During the period that obesity has become a worldwide epidemic, new interventions have been developed to combat this complex disorder. The development of new laparoscopic and minimally invasive treatments for medically-complicated obesity has made it essential that gastrointestinal physicians obtain a thorough understanding of past developments and possible future directions in bariatrics. New laparoscopic advancements provide patients and practitioners with a variety of options that have an improved safety profile and better efficacy without open, invasive surgery. The mechanisms of weight loss after bariatric surgery are complex and may in part be related to altered release of regulatory peptide hormones from the gut. Endoscopic techniques designed to mimic the effects of bariatric surgery and endolumenal interventions performed entirely through the gastrointestinal tract offer potential advantages. Several of these new techniques have demonstrated promising, preliminary results. We outline herein historical and current trends in the development of bariatric surgery and its transition to safer and more minimally invasive procedures designed to induce weight loss.

Keywords: Bariatric surgery; Bariatrics; Endoscopy; Obesity; Weight loss.

Figure 1

Comparison of bariatric surgical procedures. The major restrictive bariatric procedures depicted at the top of the figure include the adjustable gastric banding and sleeve gastrectomy. The restrictive and malabsorptive procedures are depicted in the bottom of the figure. There are elements of both food restriction as well as malabsorption in patients who have undergone either Roux-en-Y gastric bypass or sleeve gastrectomy with duodenal switch. The major malabsorptive bariatric procedure is the biliopancreatic diversion. Reprinted by permission from Ref [34].