Restrictive surgery in obesity treatment

Obesity is widely recognized as epidemic of the 21st century. Throughout Europe and the USA, it shows one of the greatest prevalences among serious life-threatening diseases. This overview of historical development of restrictive bariatric procedures and of basic patient selection criteria for restrictive procedures is based on a literature review as well as on almost 20-year personal experience in bariatric surgery. Bariatric surgical community accepts as routine procedures for obesity treatment three categories of interventions. i) Malabsorptive operations (i.e. biliopancreatic diversion and duodenal switch) that control digestion and absorption of food. ii) Combined procedures (gastric bypass in several variations, i. e. short and long limb Roux-en-Y bypass) that combine effect of gastric volume restriction with a degree of malabsorption which is determined by the length of bypassed intestine. iii) Restrictive operations (i. e. gastric banding and vertical banded gastroplasty) restricting the amount of food that can be eaten at a time. Although the operations can be performed either by open surgery or laparoscopy, the majority of them became laparoscopic procedures. All bariatric procedures offer long-term successful and substantial weight losses in appropriately selected patients. Restrictive procedures are the least invasive within the bariatric surgical armamentarium but necessitate patient-specific preoperative team assessment and selection. Focused pre- and postoperative patient education might contribute to long-term weight losses and decrease complication rates following restrictive procedures.