ABSTRACT
The surgical management of obesity, referred to as bariatric surgery, which is derived from the Greek word barrios for weight, originated in the 1950s. Introduction of new, less-invasive surgical platforms (e.g., laparoscopic, single incision laparoscopic, and robotic), surgical procedures (e.g., sleeve gastrectomy and gastric plication), and endoscopic interventions (e.g., endoluminal barriers) in the last decade has led to fundamental changes in this eld. In addition, one of the most considerable changes has been the focus on the potential of gastrointestional (GI) surgery to treat the metabolic comorbidities of obesity, and not just obesity itself. Due to impressive metabolic impacts on type 2 diabetes mellitus (T2DM), hypertension, and dyslipidemia, among others, many refer to these procedures as “metabolic surgery.”1-4
Because the relative ineffectiveness of conventional weight loss therapies in severely obese individuals has been made evident, a remarkable increase in interest in bariatric surgery has occurred in the last two decades.5 On the basis of data of 2008, an estimated 350,000 bariatric procedures per year were performed worldwide, which correspond to an absolute growth rate of 135% since 2003.6 Nonetheless, relatively few qualied patients have access to bariatric surgery. Currently, less than 2% of eligible patients are undergoing surgical treatment for obesity annually.5,7
According to the 1991 consensus guidelines from the National Institutes of Health (NIH), the eligibility criteria
for bariatric surgery include patients with a body mass index (BMI) ≥40 kg/m2, or those with a BMI ≥35 kg/m2 with signicant obesity-related comorbidities.8 In addition, surgical candidates must also meet additional criteria, including failed previous weight loss attempts, the patient’s commitment to longterm follow-up and aftercare, absence of ongoing substance abuse or unstable psychiatric illness, and absence of severe medical conditions making anesthesia or surgery very risky (Table 29.1). Overall, medical, social, and psychological aspects of the individual patient should be considered to determine the eligibility for weight loss surgery. Age per se is not a limiting factor and carefully selected elderly and adolescents can benet signicantly from bariatric surgery.7-10 Table 29.2 summarizes potential contraindications of bariatric surgery.7
