Skip to main content

Advertisement

SpringerLink
Log in

Laparoscopic surgical concepts of morbid obesity

  • Current Concepts in Clinical Surgery
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

According to the WHO, obesity and obesity with associated morbidity constitute a chronic, multi-factorial condition requiring treatment. Conservative treatment has been shown in long-term studies to be ineffective in morbid obesity. Surgical treatments break down into restrictive, malabsorptive, combined restrictive and malabsorptive or motility-reducing procedures.

Method and results

Laparoscopic implantation of an adjustable gastric band is an efficient restrictive measure for treating the majority of patients with this condition. The adjustable gastric band enables weight loss and food intake to be adapted to the individual patient’s need. Of these patients, 80–90% can expect to lose 55–70% of their excess weight. Vertical banded gastroplasty is losing ground among the restrictive options. Preliminary experiences are encouraging, but the long-term results are disappointing when assessed by the standard criteria. Gastric bypass is gaining ground in Europe and is a standard procedure in the USA. This operation is estimated to give a 70–80% loss in excess weight, and provides a better quality of life than do restrictive procedures. The biliopancreatic diversion with duodenal switch combines a sleeve gastrectomy with a duodeno-ileal switch to achieve maximum weight loss. Consistent excess weight loss of between 70% and 80% is achieved, with acceptable decreased long-term nutritional complications. The laparoscopic approach to this procedure has successfully created a surgical technique with optimum benefit and minimal morbidity, especially in the super-obese patient. Intra-gastric stimulation is the least invasive surgical procedure at present. However, the excess weight loss is lowest with this method, at only 32% in the first 2 years after the operation.

Conclusion

Provided that safety recommendations are observed, laparoscopic operations for obesity have a fairly low risk. The mortality rate in centres with experienced staff is less than 0.3%. The death rate due to untreated morbid obesity is significantly higher than in a comparable group of patients after surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Council on Scientific Affairs (1988) Treatment of obesity in adults. JAMA 260:2547–2551

    PubMed  Google Scholar 

  2. Segal L, Carter R, Zimmet P (1994) The cost of obesity, the Australian perspective. Pharmacoeconomics 5 [Suppl 1]:45–52

    Google Scholar 

  3. Martin LF, Hunter S, Lauve R, O’Leary JP (1995) Severe obesity: expensive to society, frustrating to treat, but important to confront. South Med J 88:895–902

    CAS  PubMed  Google Scholar 

  4. National Institute of Health (1985) Health implications of obesity, 59

  5. National Institute of Health Consensus Statement (1991) Gastrointestinal surgery for severe obesity. 9:1

  6. Finigan KM, Martin LF, Robinson AF, Roth N (1997) Improvement in quality of life one year after gastric Lap-Band. Obes Surg 7:281

    Google Scholar 

  7. Miller K, Mayer E, Pichler M, Hell E (1997) Quality-of-life outcomes of patients with the LAP-BAND versus non-operative treatment of obesity. Preliminary results of an ongoing long-term follow-up study. Obes Surg 7:280

    Google Scholar 

  8. Chua TY, Mendiola RM (1995) Laparoscopic vertical banded gastroplasty: the Milwaukee experience. Obes Surg 5:77–80

    Article  PubMed  Google Scholar 

  9. Wittgrove AC, Clark GW, Schubert KR (1996) Laparoscopic gastric bypass, Roux-en-Y: technique and results in 75 patients with 3–30 months follow-up. Obes Surg 6:500–504

    Article  PubMed  Google Scholar 

  10. Cleator IGM, Litwin D, Phang PT, Brosseuk DT, Rae AJ (1994) Laparoscopic ileogastrostomy for morbid obesity. Obes Surg 4:358–360

    Article  PubMed  Google Scholar 

  11. Sugerman HJ, Brewer WH, Shiffman ML, et al. (1995) A multicenter, placebo-controlled, randomized, double-blind, prospective trial of prophylactic ursodiol for the prevention of gallstone formation following gastric-bypass-induced rapid weight loss. Am J Surg 169:91–96

    Article  CAS  PubMed  Google Scholar 

  12. Wittgrove AC, Clark GW (2000) Laparoscopic gastric bypass: a five year prospective study of 500 patients followed from 3 to 60 months. Obes Surg 10:233–239

    CAS  PubMed  Google Scholar 

  13. Lönroth H, Dalenbäck J, Haglind E, Lundell L (1996) Laparoscopic gastric bypass. Surg Endosc 10:636–638

    Article  PubMed  Google Scholar 

  14. Pories WJ, MacDonald KG Jr, Morgan EJ, Sinha MK, Dohm GL, Swanson MS, et al. (1992) Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Clin Nutr 55 [2 Suppl]:582–585

  15. Sugerman HJ, Kellum JM, Engle KM, Wolfe L, Starkey JV, Birkenhauer R, et al. (1992) Gastric bypass for treating severe obesity. Am J Clin Nutr 55 [2 Suppl]:560–566

    Google Scholar 

  16. Hell E, Miller K, Moorehead MK, Samuels N (2000) Evaluation of health status and quality of life after bariatric surgery: comparison of standard Roux-en-Y gastric bypass, vertical banded gastroplasty and laparoscopic adjustable gastric banding. Obes Surg 10:214–219

    Article  CAS  PubMed  Google Scholar 

  17. MacLean LD, Rhode B, Forse RA, Nohr C (1995) Surgery for obesity—an update of a randomized trial. Obes Surg:8:145–153

    Google Scholar 

  18. Higa KD, Ho T, Boone KB (2001) Laparoscopic Roux-en-Y gastric bypass: technique and 3-year follow-up. J Laparoendosc Adv Surg Tech A 11:377–382

    Article  CAS  PubMed  Google Scholar 

  19. Scopinaro N, Adami GF, Marinari GM, Gianetta E, Traverso E, Friedman D, Camerini G, Baschieri G, Simonelli A (1998) Biliopancreatic diversion. World J Surg 22:936–946

    Article  CAS  PubMed  Google Scholar 

  20. Scopinaro N, Marinari GM, Camerini G (2002) Laparoscopic standard biliopancreatic diversion: technique and preliminary results. Obes Surg 12:362–365

    Article  PubMed  Google Scholar 

  21. Baltasar A, Bou R, Miro J, Bengochea M, Serra C, Perez N (2002) Laparoscopic biliopancreatic diversion with duodenal switch: technique and initial experience. Obes Surg 12:245–248

    Article  CAS  PubMed  Google Scholar 

  22. Feng JJ, Gagner M (2002) Laparoscopic biliopancreatic diversion with duodenal switch. Semin Laparosc Surg 9:125–129

    Article  PubMed  Google Scholar 

  23. Marceau P, Hould FS, Simard S, Lebel S, Bourque RA, Potvin M, Biron S (1998) Biliopancreatic diversion with duodenal switch. World J Surg 22:947–954

    Article  CAS  PubMed  Google Scholar 

  24. Kim WW, Gagner M, Kini S, Inabnet WB, Quinn T, Herron D, Pomp A (2003) Laparoscopic vs open biliopancreatic diversion with duodenal switch: a comparative study. J Gastrointest Surg 7:552–557

    Article  PubMed  Google Scholar 

  25. Hess DW, Hess DS (1994) Laparoscopic vertical banded gastroplasty with complete transection of the staple-line. Obes Surg 4:44–46

    Article  PubMed  Google Scholar 

  26. Natalini G, Breccolotto F, Carloni G, Calzoni L (1999) Laparoscopic adjustable vertical banded gastroplasty: a new method for treatment of morbid obesity: preliminary experience. Obes Surg 9:55–56

    Article  CAS  PubMed  Google Scholar 

  27. MacLean LD, Rhode BM, Forse RA (1990) Late results of vertical banded gastroplasty for morbid and super obesity. Surgery 107:20–27

    CAS  PubMed  Google Scholar 

  28. Verselewel de Witt Hamer PC, Hunfeld MA, Tuinebreijer WE (1999) Obesity surgery: discouraging long term results with Mason’s vertical banded gastroplasty. Eur J Surg 165:855–860

    Article  PubMed  Google Scholar 

  29. Miller K, Höller E, Hell E (2002) Restrictive procedures in the treatment of morbid obesity—vertical banded gastroplasty vs adjustable gastric banding. Zentralbl Chir127:1038–1042

    Article  Google Scholar 

  30. Belachew M, Legrand M, Jaquet N (1993) Laparoscopic placement of adjustable silicone gastric banding in the treatment of morbid obesity: an animal model experimental study. Obes Surg 3:140

    Article  Google Scholar 

  31. Belachew M, Legrand M, Vincent V, Lismonde M, Le Docte N, Deschamps V (1998) Laparoscopic adjustable gastric banding. World J Surg 22:955–963

    CAS  Google Scholar 

  32. Doherty C, Maher JW, Heitshusen DS (1997) Prospective investigation of complications, reoperations, and sustained weight loss with an adjustable gastric banding device for treatment of morbid obesity. Presented at the Digestive Disease Conference, Washington DC, May 1997

  33. Fox SR, Fox K, Hyun K (1998) The adjustable silastic gastric band versus the vertical banded gastroplasty: 7-year outcomes. Obes Surg 8:379

    Article  Google Scholar 

  34. Favretti F, Cadiere GB, Segato G, Bruyns G, De Marchi F, Himpens J, Foletto M, Lise M (1995) Laparoscopic adjustable silicone gastric banding: technique and results. Obes Surg 5:364–371

    Article  PubMed  Google Scholar 

  35. Alvarez-Cordero R, Castillo-Gonzalez A, Ramirez-Wiella G, Aragon-Viruette E (1998) Lessons learned after 2 years LAP-BAND experience. Obes Surg 8:395

    Article  Google Scholar 

  36. Berrevoet F, Pattyn P, Hesse UJ, de Hemptinne B (1998) Retrospective analysis of laparoscopic gastric banding technique: short and mid-term follow-up. Obes Surg 8:361

    Google Scholar 

  37. Chelala E, Cadiére GB, Favretti F, Himpens J, Vertruyen M, Bruyns J, Maroquin L, Lise M (1997) Conversions and complications in 185 laparoscopic adjustable silicone gastric banding cases. Surg Endosc 11:268–271

    Article  CAS  PubMed  Google Scholar 

  38. O’Brian P, Brown W, Smith A, McMurrick PJ, Stephens M (1999) Prospective study of a laparoscopically placed, adjustable gastric band in the treatment of morbid obesity. Br J Surg 85:113–118

    Article  Google Scholar 

  39. Belva PH, Takieddine M, Lefebvre JC, Vaneukem P (1998) Laparoscopic LAP-BAND gastroplasty: European results. Obes Surg 8:364

    Google Scholar 

  40. Forsell P, Hallberg D, Hellers G (1993) Gastric banding for morbid obesity: initial experience with a new adjustable band. Obes Surg 3:369–374

    Article  PubMed  Google Scholar 

  41. Forsell P, Hellers G (1997) The Swedish adjustable gastric banding for morbid obesity—nine year experience and a four year follow-up of patients operated with a new adjustable band. Obes Surg 7:345–351

    Article  CAS  PubMed  Google Scholar 

  42. Forsell P, Hellers G, Hell E (1998) The Swedish adjustable gastric banding (SAGB) for morbid obesity—weight loss, complications, pouch volume, and stoma diameter in a four-year follow up. Acta Chir Austriaca 30:161–165

    Google Scholar 

  43. Catona A, La Manna L, Forsell P (2000) The Swedish adjustable gastric band: laparoscopic technique and preliminary results. Obes Surg 10:15–21

    Article  CAS  PubMed  Google Scholar 

  44. Belva PH, Takieddine M, Lefebvre JC, Vaneukem P (1998) Laparoscopic LAP-BAND gastroplasty: European results. Obes Surg 8:364

    Google Scholar 

  45. De Jong JR, van Ramshorst B (1998) Re-interventions after laparoscopic gastric banding. Obes Surg 8:386

    Google Scholar 

  46. Elmore U, Restuccia A, Perrotta N, Polito D, De Leo A, Silecchia G, Basso N (1998) Laparoscopic adjustable silicon gastric banding (LASGB): analyses of 64 consecutive patients. Obes Surg 8:399

    Google Scholar 

  47. Angrisani L, Lorenzo M, Santoro T, Nicodemi O, Da Prato D, Ciannella M, Persico G, Tesauro B (1998) Follow-up of LAP-BAND complications. Obes Surg 8:384

    Google Scholar 

  48. Dargent J (1999) Laparoscopic adjustable gastric banding: lessons from the first 500 patients in a single Institution. Obes Surg 9:446–452

    Article  CAS  PubMed  Google Scholar 

  49. Favretti F, Cadiere GB, Segato G, De Marchi F, et al. (1999) Lap-band for the treatment of morbid obesity. A 6-year experience of 509 patients. Obes Surg 9:327

    Google Scholar 

  50. Klaiber C, Metzger A, Forsell P (2000) Laparoskopisches gastric banding. Chirurg 71:146–151

    CAS  PubMed  Google Scholar 

  51. Miller K, Hell E (1999) Laparoscopic adjustable gastric banding: a prospective 4-year follow-up study. Obes Surg 9:183–187

    Article  CAS  PubMed  Google Scholar 

  52. Stieger R, Thurnheer M, Lange J (1998) Morbid obesity: 130 consecutive patients with laparoscopic gastric banding. Schweiz Med Wochenschr 128:1239–1246

    Google Scholar 

  53. Miller K, Hell E (1999) The adjustable silicone gastric band (Lap-Band) versus the Swedish adjustable gastric band (SAGB)—a prospective randomized study. Obes Surg:9:329

    Google Scholar 

  54. Cigaina V, Pinato GP, Rigo V, Bevilacqua M, Ferraro F, Ischia S, Saggioro A (1996) Gastric peristalsis control by mono situ electrical stimulation: a preliminary study. Obes Surg 6:247–249

    Article  PubMed  Google Scholar 

  55. Cigaina V, Saggioro A, Rigo V, Pinato GP, Ischia S (1996) Long-term effects of gastric pacing to reduce feed intake in swine. Obes Surg 6:250–253

    Article  PubMed  Google Scholar 

  56. Miller K (2002) Implantable electrical gastric stimulation to treat morbid obesity in the human: operative technique. Obes Surg 12:17S–20S

    Article  PubMed  Google Scholar 

  57. Miller K, Höller E, Hell E (2002) Intragastric stimulation (IGS) for the treatment of morbid obesity. Zentralbl Chir 127:1049–1054

    Article  CAS  PubMed  Google Scholar 

  58. Gordon T, Kannel WB (1976) Obesity and cardiovascular disease: the Framingham study. Clin Endocrinol Metab 5:367–375

    CAS  PubMed  Google Scholar 

  59. Dixon JB, O’Brien PE (1999) Gastroesophageal reflux in obesity: the effect of LAP-BAND placement. Obes Surg 9:527–531

    Article  CAS  PubMed  Google Scholar 

  60. Dixon JB, Chapman L, O’Brien P (1999) Marked Improvement in asthma after LAP-BAND surgery for morbid obesity. Obes Surg 9:385–389

    Article  CAS  PubMed  Google Scholar 

  61. Alvarez-Cordero R, Ramirez-Wiella G, Aragon-Viruette E, Toledo-Delgado A (1998) Laparoscopic gastric banding: initial two year experience. Obes Surg 8:360

    Article  Google Scholar 

  62. O’Brian P, Brown W, Smith A, Chapman L, Kotzander A, Dixon J, Stephens M (1998) The LAP-BAND provides effective control of morbid obesity—a prospective study of 350 patients followed for up to 4 years. Obes Surg 8:398

    Google Scholar 

  63. MacGregor AMC (1999) Effect of surgically induced weight loss on asthma in the morbidly obese. Obes Surg 3:15–21

    Article  Google Scholar 

  64. Amaral JF, Tsiaris W, Morgan T, Thomson WR (1987) Reversal of benign intracranial hypertension by surgically induced weight loss. Arch Surg 122:946–949

    CAS  PubMed  Google Scholar 

  65. Pories WJ, MacDonald KG, Jr, Morgan EJ, Sinha MK, Dohm GL, Swanson MS, et al. (1992) Surgical treatment of obesity and its effect on diabetes: 10-y follow-up. Am J Clin Nutr 55 [2 Suppl]:560–566

  66. Miller K, Hell E, Schoen E, Ardelt E (1998) Quality of life outcome of patients with the LAP-BAND vs vertical banded gastroplasty: results of a long-term follow-up study. Obes Surg 8:359

    Google Scholar 

  67. Weiner R, Wagner D, Datz M, Bockhom H (1999) Quality of life outcome after laparoscopic gastric banding. Obes Surg 9:336

    Google Scholar 

  68. Favretti F, Cadiere GB, Segato G, Busetto L, et al. (1998) Bariatric analysis and reporting outcome system (BAROS) applied to laparoscopic gastric banding patients. Obes Surg 8:500–504

    Article  CAS  PubMed  Google Scholar 

  69. Oria HE, Moorehead MK (1998) Bariatric analysis and reporting outcome system (BAROS). Obes Surg 8:487–499

    Article  CAS  PubMed  Google Scholar 

  70. Drenick EJ, Bale GS, Seltzer F, Johnson DG (1980) Excessive mortality and causes of death in morbidly obese men. JAMA 243:443–445

    Article  CAS  PubMed  Google Scholar 

  71. Martin LF, Finigan KM, Rabner JG, Greenstein RJ (1997) Adjustable gastric banding and pregnancy. Obes Surg 7:280

    Google Scholar 

  72. Doldi SB, Micheletto G, Lattuada E, Zappa MA (1997) Surgical procedure for morbid obesity: our 20 years’ experience. Obes Surg 7:294

    Google Scholar 

  73. Miller K, Hell E (1999) Orlistat treatment after failure of the adjustable gastric band system. Obes Surg 4:333

    Google Scholar 

  74. Wadden TA (1993) Treatment of obesity by moderate and severe caloric restriction. Results of clinical research trials. Ann Intern Med 119:688–693

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgical Division, Ludwig-Boltzmann Institute for Gastroenterology and Experimental Surgery, Austrian General Hospital, Bürgermeisterstrasse 34, 4500, Hallein, Austria

    K. Miller & E. Hell

Authors
  1. K. Miller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. E. Hell
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to K. Miller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miller, K., Hell, E. Laparoscopic surgical concepts of morbid obesity. Langenbecks Arch Surg 388, 375–384 (2003). https://doi.org/10.1007/s00423-003-0420-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-003-0420-4

Keywords

Search

Navigation