Review

Surgery for Obesity: Panacea or Pandora's Box?
Rahul Pannala^a, Mark Kidd^b, Irvin M. Modlin<sup>b

a</sup>Department of Internal Medicine, Bridgeport Hospital/Yale University, Bridgeport, Conn., and
^bDepartment of Gastrointestinal Surgery, Yale University School of Medicine, New Haven, Conn., USA

Address of Corresponding Author

Dig Surg 2006;23:1-11 (DOI: 10.1159/000092800)

  Key Words

• Obesity, surgery
• Bariatric surgery

  Abstract

Background: Given the increasing prevalence of obesity, healthcare providers should be cognizant of various non-operative (diet, exercise, behavior therapy, and medications) and operative obesity treatments. This review critically evaluates these treatments, especially bariatric surgeries. Methods: Medline analyses using a combination of the following terms: obesity, bariatric surgery, and outcomes were performed with particular emphasis on prospective studies and randomized trials. Results: Non-operative treatments result in modest sustained weight loss (5-8%) at one year. Surgery is recommended for those with BMI >40 or >35 with comorbidities. Laparoscopic adjustable gastric banding, a restrictive procedure, causes 35-54% excess weight loss (EWL) at 1 year. Malabsorptive procedures (biliopancreatic diversions with and without duodenal switch) induce 72-77% EWL but are only performed at few centers. Roux-en-Y gastric bypass, acting through a combination of restriction and malabsorption, results in 69% EWL at 1 year and 49% at 14 years. Each procedure is associated with unique anatomic and nutritional complications. Overall, operative treatment improves comorbidities and may improve all-cause mortality. Conclusions: Surgery is an effective long-term treatment for selected obese patients who have failed other treatments. Further research is needed on prospective comparisons of procedures, evaluation of long-term outcomes, especially between centers and increasingly unrealistic patient expectations.

Copyright © 2006 S. Karger AG, Basel

  Author Contacts

Irvin M. Modlin, MD, PhD, FRCS
Yale University School of Medicine
POB 208062, New Haven, CT 06520 (USA)
Tel. +1 203 785 5429, Fax +1 203 737 4067
E-Mail imodlin@optonline.net

  Article Information

Published online: April 20, 2006
Number of Print Pages : 11
Number of Figures : 1, Number of Tables : 2, Number of References : 100