Journal of Gastrointestinal Surgery

, Volume 11, Issue 3, pp 377–397 | Cite as

Surgery for Obesity: A Review of the Current State of the Art and Future Directions

  • Stephen S. McNatt
  • James J. Longhi
  • Charles D. Goldman
  • David W. McFadden


The number of patients undergoing surgery for the treatment of obesity, and the proportion of the health care budget dedicated to this health problem, is growing exponentially. There are several competing surgical approaches for the management of morbid obesity. We review the literature relating to four of these: gastric bypass, biliopancreatic diversion, gastric banding, and gastric pacing. Our review finds that while enhancing the malabsorptive activity of these procedures may induce an incremental increase in excess body weight loss, the proportion of patients who fail to lose more than 50% of their excess body weight is similar no matter how radical is the surgery performed. There is little guidance from the literature as to appropriate patient selection for the varying procedures, and anonymously reported registries have yet to show that patients who undergo bariatric surgery have enhanced longevity. To date, the bariatric surgical community has not conducted adequately powered randomized prospective trials to elucidate key elements of the surgical procedure such as optimal bypass length, to determine whether mixed operations are superior to those that offer intake restriction only, and to define what constitutes success after bariatric surgery. As a public health measure, bariatric surgery in the United States is being pursued in an irrational manner, being concentrated in areas where there are fewer morbidly obese patients, and used disproportionately among the population of white obese females.


Obesity Surgical treatment Biliopancreatic diversion Roux-en-Y gastric bypass Adjustable gastric banding Gastric pacing 


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Stephen S. McNatt
    • 1
    • 3
  • James J. Longhi
    • 1
    • 3
  • Charles D. Goldman
    • 2
    • 3
    • 4
  • David W. McFadden
    • 3
  1. 1.West Virginia University Minimally Invasive Surgery CenterWest Virginia UniversityMorgantownUSA
  2. 2.Bariatric and Oncologic SurgeryWest Virginia UniversityMorgantownUSA
  3. 3.Department of SurgeryWest Virginia UniversityMorgantownUSA
  4. 4.Department of Surgery, Robert C. Byrd Health Science CenterWest Virginia UniversityMorgantownUSA

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