SAGES guideline for clinical application of laparoscopic bariatric surgery

Bariatric surgery is medically indicated for morbidly obese patients who fail to respond to dietary, behavioral, nutritional, and medical therapies, with clear evidence of efficacy and safety. BMI and age-based candidacy guidelines should not limit access for patients suffering with progressive or poorly controlled obesity-related comorbidities if the risk-versus-benefit analysis favors surgery. Laparoscopic RGB, AGB, and BPD have all been proven effective. Given the marked paucity of prospectively collected comparative data between the different bariatric operations, it remains impossible to make definitive recommendations for one procedure over another. At the present time, decisions are driven by patient and surgeon preferences, as well as considerations regarding the degree and timing of necessary outcomes versus tolerance of risk and lifestyle change. Until the emergence of additional randomized controlled comparative studies, decisions between procedures will depend upon the present evidence and the relative importance placed by patients and surgeons on purported discriminating factors. © 2009 SAGES 2008.