Laparoscopic revolution in bariatric surgery

Abstract

The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21(st) century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.

Keywords: Bariatric surgery; Duodenal switch; Gastric banding; Gastric bypass; Laparoscopy; Metabolic surgery; Minimal invasive surgery.

Figure 1

Landmarks for important bariatric procedures, jejuno-ileal bypass, vertical banded gastroplasty, gastric bypass, bileo-pancreatic diversion, duodenal switch, and adjustable gastric banding, including schematic drawings.

Figure 2

Proportion of bariatric surgery that was performed with laparoscopic approach world wide. In 2003-2008, a concurrent increase from 146000 to 340000 annual procedures was seen.

Figure 3

Proportion of the three major bariatric procedures, gastric bypass, adjustable gastric banding, and sleeve gastrectomy, performed world wide 2003-2011. Major part, but not all are performed with laparoscopic technique. Data are adopted from Buchwald et al[42,43,47].