This observational clinical analysis included 246 patients who underwent surgery for adjustable gastric banding (AGB), laparoscopic sleeve gastrectomy (LSG), or gastric bypass (GBP) between May 2005 and December 2008. The most frequent surgical procedure was for AGB (73.2% of patients). A thorough psychological evaluation of the patients was carried out, and pre-and post-operative psychological and dietary support was offered. A total of 111/120 (92.5%) AGB patients, 21/30 (70.0%) LSG patients and 8/36 (22.2%) GBP patients have been monitored for at least 1 year, and their mean weight losses (percentage excess weight loss) were 24.7 kg (52.4%), 46.0 kg (57.9%) and 40.5 kg (77.9%), respectively. The AGB procedure was associated with the fewest complications but is not appropriate for all patients. Good pre-operative psychological evaluation has been shown to be necessary for successful outcomes and, in the super-obese, we prefer to use LSG. Surgeons should learn the skills needed to perform laparoscopic Roux-en-Y GBP as it is likely to become the standard-of-care for the surgical treatment of obesity. The best outcomes following bariatric surgery are achieved with a multidisciplinary approach, including participation in a support group guided by a psychologist.
UngerF: Health is wealth–toward a European lead market in health care. Acta Medico-Biotechnica2008; 1: 11–18.
2.
ChristouNVSampalisJSLibermanM: Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg2004; 240: 416–423.
3.
Abu-AbeidSKeidarASzoldA: Resolution of chronic medical conditions after laparoscopic adjustable silicone gastric banding for the treatment of morbid obesity in the elderly. Surg Endosc2001; 15: 132–134.
4.
MasonEETangSRenquistKE: A decade of change in obesity surgery. Obes Surg1997; 7: 189–197.
5.
WeissRDziuraJBurgertTS: Obesity and the metabolic syndrome in children and adolescents. N Engl J Med2004; 350: 2362–2374.
6.
CookSWeitzmanMAuingerP: Prevalence of a metabolic syndrome phenotype in adolescents: Findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med2003; 157: 821–827.
7.
GoodmanEDanielsSRMeigsJB: Instability in the diagnosis of metabolic syndrome in adolescents. Circulation2007; 115: 2316–2322.
8.
SjöströmLV: Mortality of severely obese subjects. Am J Clin Nutr1992; 55 (2 suppl): 516S–523S.
9.
MillerK: Laparoscopic bariatric surgery in the treatment of morbid obesity. Endosc Rev2005; 24: 73–88.
10.
Treatment of obesity in adults. Council on Scientific Affairs. JAMA1988; 260: 2547–2551.
11.
National Institutes of Health consensus development conference statement. Health implications of obesity. Ann Intern Med1985; 103: 1073–1077.
12.
OppertJMRolland-CacheraMF: Prevalence, time trends, and the economic cost of obesity. Med Sci1998; 14: 939–943 [in French].
13.
De WitLTMathus-VliegenLHeyC: Open versus laparoscopic adjustable silicone gastric banding. A prospective randomised trial for treatment of morbid obesity. Ann Surg1999; 230: 800–805.
14.
PayneJHDeWindLT: Surgical treatment of obesity. Am J Surg1969; 118: 141–147.
15.
MasonEEItoC: Gastric bypass. Ann Surg1969; 170: 329–339.
16.
GriffenWOJrBivinsBABellRM: The decline and fall of the jejunoileal bypass. Surg Gynecol Obstet1983; 157: 301–308.
17.
HalversonJDWiseLWaznaMF: Jejunoileal bypass for morbid obesity. A critical appraisal. Am J Med1978; 64: 461–475.
18.
BelachewMLegrandMVincentV: Celioscopic approach in surgical treatment of morbid obesity. Technique and results. Ann Chir1997; 51: 165–172 [in French].
19.
GravanteGAracoAAracoF: Laparoscopic adjustable gastric bandings: A prospective randomized study of 400 operations performed with 2 different devices. Arch Surg2007; 142: 958–961.
20.
American Gastroenterological Association medical position statement on obesity. Gastroenterology2002; 123: 879–881.
21.
KleinSWaddenTSugermanHJ: AGA technical review on obesity. Gastroenterology2002; 123: 882–932.
22.
PrattJSABlackburnGL: Surgical approaches to the treatment of obesity: A practical guide for the covering physician. In: Office Management of Obesity, 1st edn (BrayGA, ed). Philadelphia: Elsevier, 2003; pp 275–298.
23.
SchauerPRIkramuddinSGourashW: Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg2000; 232: 515–529.
24.
BuchwaldHAvidorYBraunwaldE: Bariatric surgery: A systematic review and meta-analysis. JAMA2004; 292: 1724–1737.
25.
MaggardMAShugarmanLRSuttorpM: Meta-analysis: Surgical treatment of obesity. Ann Intern Med2005; 142: 547–559.
26.
LancasterRTHutterMM: Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc2008; 22: 2554–2563.
27.
HollenbeakCSRogersAMBarrusB: Surgical volume impacts bariatric surgery mortality: A case for centers of excellence. Surgery2008; 144: 736–743.
28.
DiGiorgiMDaudAInabnetWB: Markers of bone and calcium metabolism following gastric bypass and laparoscopic adjustable gastric banding. Obes Surg2008; 18: 1144–1148.
29.
YbarraJSanchez-HernandezJGichI: Hypovitaminosis D and secondary hyperparathyroidism in morbid obesity after bariatric surgery. Obes Surg2005; 15: 330–335.
30.
CoatesPSFernstromJDFernstromMH: Gastric bypass surgery for morbid obesity leads to an increase in bone turnover and a decrease in bone mass. J Clin Endocrinol Metab2004; 89: 1061–1065.
31.
Gastrointestinal surgery for severe obesity. Proceedings of a National Institutes of Health Consensus Development Conference, March 25–27, 1991, Bethesda, MD. Am J Clin Nutr1992; 55 (2 suppl): 487S–619S.
32.
PoriesWJSwansonMSMacDonaldKG: Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg1995; 222: 339–352.
33.
O'BrienPEBrownWASmithA: Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg1999; 86: 113–118.
34.
AlmogyGCrookesPFAnthoneGJ: Longitudinal gastrectomy as a treatment for the high-risk super-obese patient. Obes Surg2004; 14: 492–497.
35.
ReganJPInabnetWBGagnerM: Early experience with two-stage laparoscopic Roux-en-Y gastric bypass as an alternative in the super-super obese patient. Obes Surg2003; 13: 861–864.
36.
KaramanakosSNVagenasKKalfarentzosF: Weight loss, appetite suppression, and changes in fasting and post-prandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: A prospective, double blind study. Ann Surg2008; 247: 401–407.
37.
MoyJPompADakinG: Laparoscopic sleeve gastrectomy for morbid obesity. Am J Surg2008; 196: e56–e59.
38.
Society of American Gastrointestinal Endoscopic Surgeons: Guidelines for institutions granting bariatric privileges utilizing laparoscopic techniques. Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and the SAGES Bariatric Task Force. Surg Endosc2003; 17: 2037–2040.
39.
OriaEHMooreheadKM: Bariatric analysis and reporting outcome system (BAROS). Obes Surg1998; 8: 487–499.
WiseMWMartinLFO'LearyJP: Morbid obesity. In: Current Surgical Therapy, 7th edn (CameronJL, ed.). St Louis: Mosby, 2001; pp 98–105.
42.
ZinzindohoueFChevallierJ-MDouardR: Laparoscopic gastric banding: A minimally invasive surgical treatment for morbid obesity. Ann Surg2003; 237: 1–9.
43.
O'BrienPEDixonJBBrownW: The laparoscopic adjustable gastric band (Lapband®): A prospective study of medium-term effects on weight, health and quality of life. Obes Surg2002; 12: 652–660.
44.
O'BrienPE: Laparoscopic adjustable gastric banding: A real option for a real problem. ANZ J Surg2003; 73: 562.
45.
BelachewMBelvaPHDesaiveC: Long-term results of laparoscopic adjustable gastric banding for the treatment of morbid obesity. Obes Surg2002; 12: 564–568.
46.
CeelenWWalderJCardonA: Surgical treatment of severe obesity with a low-pressure adjustable gastric band. Experimental data and clinical results in 625 patients. Ann Surg2003; 237: 10–16.
AllenJW: Laparoscopic gastric band complications. Med Clin North Am2007; 91: 485–497.
50.
MunECBlackburnGLMatthewsJB: Current status of medical and surgical therapy for obesity. Gastroenterology2001; 120: 669–681.
51.
MacLeanLDRhodeBMSampalisJ: Results of the surgical treatment of obesity. Am J Surg1993; 165: 155–160.
52.
SuterMJayetCJayetA: Vertical banded gastroplasty: Long-term results comparing three different techniques. Obes Surg2000; 10: 41–46.
53.
SchauerPRBurgueraBIkramuddinS: Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg2003; 238: 467–484.
54.
SugermanHJWolfeLGSicaDA: Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg2003; 237: 751–756.
55.
PerryYCourcoulasAPFernandoHC: Laparoscopic Roux-en-Y gastric bypass for recalcitrant gastroesophageal reflux disease in morbidly obese patients. JSLS2004; 8: 19–23.
56.
LaraMDKothariSNSugermanHJ: Surgical management of obesity: A review of the evidence relating to the health benefits and risks. Treat Endocrinol2005; 4: 55–64.
57.
FlumDRDellingerEP: Impact of gastric bypass operation on survival: A population-based analysis. J Am Coll Surg2004; 199: 543–551.
58.
GallagherSFBanasiakMGonzalvoJP: The impact of bariatric surgery on the Veterans Administration healthcare system: A cost analysis. Obes Surg2003; 13: 245–248.
