Metabolic and Bariatric Surgery: Evolution, Techniques, and Management

Abstract

Metabolic and bariatric surgery involves more than altering the stomach and small bowel anatomy to provoke structural changes in the gastrointestinal tract from a mechanical point of view to treat morbid obesity. Its profound impact on the body’s metabolism goes beyond anatomy and enters the realm of physiology. This is one of the most challenging and influential surgical subspecialties today due to its proven beneficial impact on the worldwide obesity epidemic and its millions of patients. A brief but comprehensive overview of the history of this fascinating yet challenging discipline and its advancement into the minimally invasive arena will be presented. Moreover, the body of this chapter will provide evidence-based data dealing with its indications, approaches, minimally invasive techniques including robotic surgery, the most common operations and the most recently introduced procedures, and management of complications. The impact of the laparoscopic revolution at the end of the twentieth century and the relevance of the robotic revolution from this century will be emphasized. An important point that will be made is the very specialized discipline of revisional bariatric surgery and its crucial role on the treatment of complications and failures that require extensive training and experience.