Open and laparoscopic surgical modalities for the management of obesity

Two major advances in surgery for morbid obesity over the past decade are responsible for the dramatic transition from skepticism to widespread adoption. The first involves the accumulation of many studies documenting reproducible long-term weight loss in the range of 50% to 70% excess weight loss for gastric bypass, with profound reduction in comorbidity and improvement in quality of life while maintaining major operative morbidity and mortality under 10% and 1%, respectively. Apart from the gastric bypass, LASG or malabsorption procedures appear to have favorable risk/benefit ratios but do not have the same weight of evidence. Although surgical management does carry a higher risk than medical management of severe obesity, it clearly is superior in terms of long-term weight loss, which at best is 10% to 15% of excess body weight for the best medical (nonsurgical) therapy. The second major advance is the development of less invasive bariatric operations that use laparoscopic techniques. The reduction in perioperative morbidity particularly related to wound complications and recovery clearly provides significant advantages over the conventional (open) approach. Essentially all major bariatric operations can now be performed laparoscopically. Patient