Surgical Management of Obesity: A Broad Overview of Bariatric and Metabolic Surgery

Abstract

Obesity is the second leading preventable cause of death globally. India has the dubious distinction of housing the third-highest number of obese people in the world. Obesity leads to several comorbid conditions that practically affect every organ of the body. Long-term results of medical therapy and lifestyle interventions for morbid obesity are dismal. Bariatric surgery has proven to be superior to medical therapy in terms of weight loss and resolution of comorbidities. Bariatric metabolic surgery may be offered to patients with body mass index (BMI) 37.5 kg/ m 2 , with or without any obesity-related comorbidity, or BMI 32.5 kg/m 2 with two or more obesity-related comorbidities. Surgery for morbid obesity would not be indicated if patients do not show a desire to adhere to long-term dietary advice or take nutritional supplements. Bariatric procedures can be classified into three types: mainly restrictive [vertical banded gastroplasty (historical), adjustable gastric banding, sleeve gastrectomy], mainly malabsorptive (duodenal switch, biliopancreatic diversion), and a combination of the two (gastric bypass). With advances in technology and the demand for less invasive weight loss therapy, all the above-mentioned procedures can be performed laparoscopically or with a robot. Endoscopic procedures and devices including intragastric balloons, endoluminal suturing, aspiration systems, and many other experimental therapies are also being tried. Post-bariatric surgery, patients have to follow a strict dietary regimen and take supplements lifelong. This review article provides a broad overview of surgical treatment of obesity and metabolic syndrome.