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Surgical Management of Obesity: Surgical Procedures, Preoperative Evaluation, and Patient Selection

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Abstract

Bariatric surgery is currently the most effective therapy available for the treatment of morbid obesity. The overall impact of these therapies on the quality and length of life is remarkable. This chapter will review current bariatric surgical procedures including vertical banded gastroplasty, laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass, biliopancreatic diversion with or without duodenal switch, and laparoscopic sleeve gastrectomy. The weight loss and comorbidity outcomes of each procedure will be compared and complications reviewed. The current criteria for patient selection and preoperative evaluation are also reviewed including preoperative eating habits, psychological and physical evaluation.

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References

  1. United States Agency for Healthcare Research and Quality, Southern California Evidence-Based Practice Center/RAND. Pharmacological and surgical treatment of obesity. Rockville, MD: U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality; 2004.

    Google Scholar 

  2. Christou NV, Sampalis JS, Liberman M, et al. Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg. 2004;240(3):416–23. discussion 423–414.

    Article  PubMed  Google Scholar 

  3. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med. 2007;357(8):753–61.

    Article  PubMed  CAS  Google Scholar 

  4. Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.

    Article  PubMed  Google Scholar 

  5. Allergan. Allergan (R). 2010. http://www.lapband.com/en/learn_about_lapband/compare_lapband/. Accessed 8 May 2010.

  6. Marceau P, Marceau S, Biron S, et al. Long-term experience with duodenal switch in adolescents. Obes Surg. 2010;20(12):1609–16.

    Article  PubMed  Google Scholar 

  7. Buchwald H, Oien DM. Metabolic/bariatric surgery Worldwide 2008. Obes Surg. 2009;19(12):1605–11.

    Article  PubMed  Google Scholar 

  8. Flum DR, Belle SH, King WC, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med. 2009;361(5):445–54.

    Article  PubMed  Google Scholar 

  9. O’Brien PE, McPhail T, Chaston TB, Dixon JB. Systematic review of medium-term weight loss after bariatric operations. Obes Surg. 2006;16(8):1032–40.

    Article  PubMed  Google Scholar 

  10. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.

    Article  PubMed  CAS  Google Scholar 

  11. Gould JC, Garren MJ, Boll V, Starling JR. Laparoscopic gastric bypass: risks vs. benefits up to two years following surgery in super-super obese patients. Surgery. 2006;140(4):524–9. discussion 529–531.

    Article  PubMed  Google Scholar 

  12. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–256.e5.

    Article  PubMed  Google Scholar 

  13. Schauer PR, Burguera B, Ikramuddin S, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84. discussion 484–465.

    PubMed  Google Scholar 

  14. Nguyen NT, Slone JA, Nguyen XM, Hartman JS, Hoyt DB. A prospective randomized trial of laparoscopic gastric bypass versus laparoscopic adjustable gastric banding for the treatment of morbid obesity: outcomes, quality of life, and costs. Ann Surg. 2009; 250(4):631–41.

    PubMed  Google Scholar 

  15. Tice JA, Karliner L, Walsh J, Petersen AJ, Feldman MD. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121(10):885–93.

    Article  PubMed  Google Scholar 

  16. Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery. 2007;142(4):621–32. discussion 632–625.

    Article  PubMed  Google Scholar 

  17. Ali MR, Fuller WD, Choi MP, Wolfe BM. Bariatric surgical outcomes. Surg Clin North Am. 2005; 85(4):835–52. vii.

    Article  PubMed  Google Scholar 

  18. Pratt GM, Learn CA, Hughes GD, Clark BL, Warthen M, Pories W. Demographics and outcomes at American Society for Metabolic and Bariatric Surgery Centers of Excellence. Surg Endosc. 2009;23(4):795–9.

    Article  PubMed  Google Scholar 

  19. Schauer PR, Ikramuddin S, Gourash W, Ramanathan R, Luketich J. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):515–29.

    Article  PubMed  CAS  Google Scholar 

  20. Higa KD, Boone KB, Ho T. Complications of the laparoscopic Roux-en-Y gastric bypass: 1,040 patients–what have we learned? Obes Surg. 2000;10(6):509–13.

    Article  PubMed  CAS  Google Scholar 

  21. Podnos YD, Jimenez JC, Wilson SE, Stevens CM, Nguyen NT. Complications after laparoscopic gastric bypass: a review of 3464 cases. Arch Surg. 2003;138(9):957–61.

    Article  PubMed  Google Scholar 

  22. Agaba EA, Shamseddeen H, Gentles CV, Sasthakonar V, Gellman L, Gadaleta D. Laparoscopic vs. open gastric bypass in the management of morbid obesity: a 7-year retrospective study of 1,364 patients from a single center. Obes Surg. 2008;18(11):1359–63.

    Article  PubMed  Google Scholar 

  23. Courcoulas A, Perry Y, Buenaventura P, Luketich J. Comparing the outcomes after laparoscopic versus open gastric bypass: a matched paired analysis. Obes Surg. 2003;13(3):341–6.

    Article  PubMed  Google Scholar 

  24. Lancaster RT, Hutter MM. Bands and bypasses: 30-day morbidity and mortality of bariatric surgical procedures as assessed by prospective, multi-center, risk-adjusted ACS-NSQIP data. Surg Endosc. 2008;22(12):2554–63.

    Article  PubMed  Google Scholar 

  25. Marema RT, Perez M, Buffington CK. Comparison of the benefits and complications between laparoscopic and open Roux-en-Y gastric bypass surgeries. Surg Endosc. 2005;19(4):525–30.

    Article  PubMed  CAS  Google Scholar 

  26. Smith SC, Edwards CB, Goodman GN, Halversen RC, Simper SC. Open vs. laparoscopic Roux-en-Y gastric bypass: comparison of operative morbidity and mortality. Obes Surg. 2004;14(1):73–6.

    Article  PubMed  Google Scholar 

  27. Tian HL, Tian JH, Yang KH, Yi K, Li L. The effects of laparoscopic vs. open gastric bypass for morbid obesity: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12(4):254–60.

    Article  PubMed  CAS  Google Scholar 

  28. Chevallier JM, Zinzindohoue F, Douard R, et al. Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years. Obes Surg. 2004;14(3):407–14.

    Article  PubMed  Google Scholar 

  29. Toouli J, Kow L, Collins J, Schloithe A, Oppermann C. Efficacy of a low-pressure laparoscopic adjustable gastric band for morbid obesity: patients at long term in a multidisciplinary center. Surg Obes Relat Dis. 2008;4(3 Suppl):S31–8.

    Article  PubMed  Google Scholar 

  30. Favretti F, Segato G, Ashton D, et al. Laparoscopic adjustable gastric banding in 1,791 consecutive obese patients: 12-year results. Obes Surg. 2007;17(2):168–75.

    Article  PubMed  Google Scholar 

  31. Tolonen P, Victorzon M, Makela J. 11-year experience with laparoscopic adjustable gastric banding for morbid obesity–what happened to the first 123 patients? Obes Surg. 2008;18(3):251–5.

    Article  PubMed  Google Scholar 

  32. Mittermair RP, Obermuller S, Perathoner A, Sieb M, Aigner F, Margreiter R. Results and complications after Swedish adjustable gastric banding-10 years experience. Obes Surg. 2009;19(12):1636–41.

    Article  PubMed  Google Scholar 

  33. Gagner M, Deitel M, Kalberer TL, Erickson AL, Crosby RD. The second international consensus summit for sleeve gastrectomy, March 19–21, 2009. Surg Obes Relat Dis. 2009;5(4):476–85.

    Article  PubMed  Google Scholar 

  34. Uglioni B, Wolnerhanssen B, Peters T, Christoffel-Courtin C, Kern B, Peterli R. Midterm results of primary vs. secondary laparoscopic sleeve gastrectomy (LSG) as an isolated operation. Obes Surg. 2009;19(4):401–6.

    Article  PubMed  Google Scholar 

  35. Fuks D, Verhaeghe P, Brehant O, et al. Results of laparoscopic sleeve gastrectomy: a prospective study in 135 patients with morbid obesity. Surgery. 2009;145(1):106–13.

    Article  PubMed  Google Scholar 

  36. Nocca D, Krawczykowsky D, Bomans B, et al. A prospective multicenter study of 163 sleeve gastrectomies: results at 1 and 2 years. Obes Surg. 2008;18(5):560–5.

    Article  PubMed  CAS  Google Scholar 

  37. Gill RS, Birch DW, Shi X, Sharma AM, Karmali S. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis. 2010;6(6):707–13.

    Article  PubMed  Google Scholar 

  38. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–75.

    Article  PubMed  Google Scholar 

  39. Scopinaro N, Marinari GM, Camerini G. Laparoscopic standard biliopancreatic diversion: technique and preliminary results. Obes Surg. 2002;12(3):362–5.

    Article  PubMed  Google Scholar 

  40. Gagner M, Matteotti R. Laparoscopic biliopancreatic diversion with duodenal switch. Surg Clin North Am. 2005;85(1):141–9. x–xi.

    Article  PubMed  Google Scholar 

  41. Colquitt JL, Picot J, Loveman E, Clegg AJ. Surgery for obesity. Cochrane Database Syst Rev. 2009;(2): CD003641. DOI: 10.1002/14651858.CD003641.pub3.

    Google Scholar 

  42. Scopinaro N, Gianetta E, Adami GF, et al. Biliopancreatic diversion for obesity at eighteen years. Surgery. 1996;119(3):261–8.

    Article  PubMed  CAS  Google Scholar 

  43. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg. 1998;8(3):267–82.

    Article  PubMed  CAS  Google Scholar 

  44. Hess DS. Biliopancreatic diversion with duodenal switch. Surg Obes Relat Dis. 2005;1(3):329–33.

    Article  PubMed  Google Scholar 

  45. Hess DS, Hess DW, Oakley RS. The biliopancreatic diversion with the duodenal switch: results beyond 10 years. Obes Surg. 2005;15(3):408–16.

    Article  PubMed  Google Scholar 

  46. Anthone GJ. The duodenal switch operation for morbid obesity. Surg Clin North Am. 2005;85(4):819–33. viii.

    Article  PubMed  Google Scholar 

  47. Marceau P, Hould FS, Simard S, et al. Biliopancreatic diversion with duodenal switch. World J Surg. 1998;22(9):947–54.

    Article  PubMed  CAS  Google Scholar 

  48. Totte E, Hendrickx L, van Hee R. Biliopancreatic diversion for treatment of morbid obesity: experience in 180 consecutive cases. Obes Surg. 1999;9(2):161–5.

    Article  PubMed  CAS  Google Scholar 

  49. Kim WW, Gagner M, Kini S, et al. Laparoscopic vs. open biliopancreatic diversion with duodenal switch: a comparative study. J Gastrointest Surg. 2003;7(4):552–7.

    Article  PubMed  Google Scholar 

  50. Scopinaro N, Marinari G, Camerini G, Papadia F. Biliopancreatic diversion for obesity: state of the art. Surg Obes Relat Dis. 2005;1(3):317–28.

    Article  PubMed  Google Scholar 

  51. Alami RS, Morton JM, Schuster R, et al. Is there a benefit to preoperative weight loss in gastric bypass patients? A prospective randomized trial. Surg Obes Relat Dis. 2007;3(2):141–5. discussion 145–146.

    Article  PubMed  Google Scholar 

  52. Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth. 2000;85(1):91–108.

    Article  PubMed  CAS  Google Scholar 

  53. Anderson JW, Brinkman-Kaplan VL, Lee H, Wood CL. Relationship of weight loss to cardiovascular risk factors in morbidly obese individuals. J Am Coll Nutr. 1994;13(3):256–61.

    PubMed  CAS  Google Scholar 

  54. Benotti PN, Still CD, Wood GC, et al. Preoperative weight loss before bariatric surgery. Arch Surg. 2009;144(12):1150–5.

    Article  PubMed  Google Scholar 

  55. Livhits M, Mercado C, Yermilov I, et al. Does weight loss immediately before bariatric surgery improve outcomes: a systematic review. Surg Obes Relat Dis. 2009;5(6):713–21.

    Article  PubMed  Google Scholar 

  56. Sugerman HJ, Starkey JV, Birkenhauer R. A randomized prospective trial of gastric bypass versus vertical banded gastroplasty for morbid obesity and their effects on sweets versus non-sweets eaters. Ann Surg. 1987;205(6):613–24.

    Article  PubMed  CAS  Google Scholar 

  57. Burgmer R, Grigutsch K, Zipfel S, et al. The influence of eating behavior and eating pathology on weight loss after gastric restriction operations. Obes Surg. 2005;15(5):684–91.

    Article  PubMed  Google Scholar 

  58. Wolnerhanssen BK, Peters T, Kern B, et al. Predictors of outcome in treatment of morbid obesity by ­laparoscopic adjustable gastric banding: results of a prospective study of 380 patients. Surg Obes Relat Dis. 2008;4(4):500–6.

    Article  PubMed  Google Scholar 

  59. Hudson SM, Dixon JB, O’Brien PE. Sweet eating is not a predictor of outcome after Lap-Band placement. Can we finally bury the myth? Obes Surg. 2002;12(6):789–94.

    Article  PubMed  Google Scholar 

  60. Miras AD, le Roux CW. Bariatric surgery and taste: novel mechanisms of weight loss. Curr Opin Gastroenterol. 2010;26(2):140–5.

    Article  PubMed  Google Scholar 

  61. Dingemans AE, Bruna MJ, van Furth EF. Binge eating disorder: a review. Int J Obes Relat Metab Disord. 2002;26(3):299–307.

    Article  PubMed  CAS  Google Scholar 

  62. Sogg S. Comment on: history of substance abuse relates to improved postbariatric body mass index outcomes. Surg Obes Relat Dis. 2010;6(4):421–2.

    Article  PubMed  Google Scholar 

  63. Niego SH, Kofman MD, Weiss JJ, Geliebter A. Binge eating in the bariatric surgery population: a review of the literature. Int J Eat Disord. 2007;40(4):349–59.

    Article  PubMed  Google Scholar 

  64. Hsu LK, Benotti PN, Dwyer J, et al. Nonsurgical factors that influence the outcome of bariatric surgery: a review. Psychosom Med. 1998;60(3):338–46.

    PubMed  CAS  Google Scholar 

  65. de Zwaan M, Hilbert A, Swan-Kremeier L, et al. Comprehensive interview assessment of eating behavior 18–35 months after gastric bypass surgery for morbid obesity. Surg Obes Relat Dis. 2010;6(1):79–85.

    Article  PubMed  Google Scholar 

  66. Wadden TA, Sarwer DB, Fabricatore AN, Jones L, Stack R, Williams NS. Psychosocial and behavioral status of patients undergoing bariatric surgery: what to expect before and after surgery. Med Clin North Am. 2007;91(3):451–69. xi–xii.

    Article  PubMed  Google Scholar 

  67. Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res. 2005;13(4):639–48.

    Article  PubMed  Google Scholar 

  68. Karlsson J, Sjostrom L, Sullivan M. Swedish obese subjects (SOS)–an intervention study of obesity. Two-year follow-up of health-related quality of life (HRQL) and eating behavior after gastric surgery for severe obesity. Int J Obes Relat Metab Disord. 1998;22(2):113–26.

    Article  PubMed  CAS  Google Scholar 

  69. Blackburn GL, Hutter MM, Harvey AM, et al. Expert panel on weight loss surgery: executive report update. Obesity (Silver Spring). 2009;17(5):842–62.

    Article  Google Scholar 

  70. Livingston EH, Arterburn D, Schifftner TL, Henderson WG, DePalma RG. National surgical quality improvement program analysis of bariatric operations: modifiable risk factors contribute to bariatric surgical adverse outcomes. J Am Coll Surg. 2006;203(5):625–33.

    Article  PubMed  Google Scholar 

  71. Azagury D, Dumonceau JM, Morel P, Chassot G, Huber O. Preoperative work-up in asymptomatic patients undergoing Roux-en-Y gastric bypass: is endoscopy mandatory? Obes Surg. 2006;16(10):1304–11.

    Article  PubMed  CAS  Google Scholar 

  72. Lautz DB, Jiser ME, Kelly JJ, et al. An update on best practice guidelines for specialized facilities and resources necessary for weight loss surgical programs. Obesity (Silver Spring). 2009;17(5):911–7.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of General and Gastrointestinal Surgery, Harvard Medical School, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Dan E. Azagury M.D.

  2. Emerson/Mass General Weight Loss Program, 54 Baker Avenue Extension, Concord, MA, 01742, USA

    David B. Lautz M.D., F.A.C.S.

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  1. Dan E. Azagury M.D.
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Correspondence to David B. Lautz M.D., F.A.C.S. .

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Editors and Affiliations

  1. Harvard Medical School, Division of Gastroenterology,, Brigham and Women's Hospital, 75 Francis St, ASB2, Boston, 02115, Massachusetts, USA

    Christopher C. Thompson

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Azagury, D.E., Lautz, D.B. (2013). Surgical Management of Obesity: Surgical Procedures, Preoperative Evaluation, and Patient Selection. In: Thompson, C. (eds) Bariatric Endoscopy. Springer, New York, NY. https://doi.org/10.1007/978-1-4419-1710-2_5

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  • DOI: https://doi.org/10.1007/978-1-4419-1710-2_5

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