Severe obesity is associated with a number of co-morbidities. Medical weight reduction programs have not been proven to have long-term efficacy for these severely obese patients. Surgically induced weight loss has been found to completely reverse or markedly ameliorate obesity-related problems. Gastric bypass has been found to provide significantly more weight loss than a purely restrictive procedure such as a vertical banded gastroplasty or adjustable silicone gastric banding. Gastric bypass may be associated with micro-nutrient deficiencies such as iron, vitamin B12, and calcium. These patients require life-long supplementation. Laparoscopic gastric bypass has been shown to be feasible and safe and equivalent to the weight loss seen following open gastric bypass. The mortality in most series of gastric bypass surgery, whether open or laparoscopic, is <1%. Problems of stomal stenosis and marginal ulcer can almost always be treated medically with endoscopic dilatation or acid suppression therapy, respectively. Copyright 2002, Elsevier Science (USA). All rights reserved.
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