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Cited by 316Bariatric Surgery and OutcomesBody Contouring and SurgeryMinimally Invasive Surgical Techniques

Medical and surgical options in the treatment of severe obesity

Fisher, Barry L, Schauer, Philip·2002·The American Journal of Surgery
DOI 10.1016/s0002-9610(02)01173-x
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Abstract

Weight loss programs, diets, and drug therapy have not shown long-term effectiveness in treating morbid obesity. A 1992 statement from the National Institutes of Health Consensus Development Conference affirmed the superiority of surgical over nonsurgical approaches to this condition. Bariatric surgical procedures work in 1 of 2 ways: by restricting a patient's ability to eat (restrictive procedures) or by interfering with ingested nutrient absorption (malabsorptive procedures). Many of these procedures can be performed by a laparoscopic approach, which has been shown to reduce operative morbidity. In the United States, the primary operative choice for morbidly obese patients has recently shifted from vertical banded gastroplasty (VBG) to the Roux-en-Y gastric bypass (RYGBP). VBG, a purely restrictive procedure, has fallen into disfavor because of inadequate long-term weight loss. RYGBP combines restriction and malabsorption principles, and has been shown to induce greater weight loss than VBG. Other procedures currently being offered include laparoscopic adjustable gastric banding; biliopancreatic diversion (BPD), including the duodenal switch (BPD-DS) variation; and distal gastric bypass (DGBP). Laparoscopic adjustable gastric banding with the LAP-BAND system (INAMED Health, Santa Barbara, CA), a restrictive procedure involving placement of a silicone band around the upper stomach, was introduced in the early 1990s and approved by the US Food and Drug Administration for use in the United States in June 2001. Outside the United States, LAP-BAND surgery is the most commonly performed operation for severe obesity. The BPD, BPD-DS, and DGBP are all malabsorptive procedures offered primarily by laparotomy. They have been shown to induce good long-term weight loss but have a higher rate of adverse nutritional complications. Many safe and effective surgical options for severe obesity are available. More scientific appraisals comparing different procedures and open and laparoscopic approaches are needed.

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Authors
Fisher, B. L., & Schauer, P.
Affiliations
  • University of Nevada, Las Vegas (US)
  • University of Pittsburgh (US)
Corresponding author
Fisher, Barry L
ORCID
Schauer, Philip
Venue
The American Journal of Surgery
Publisher
Elsevier BV
Published
2002-12
Volume
184
Issue
6
Pages
S9-S16
ISSN
0002-9610 (ISSN-L)
DOI
10.1016/s0002-9610(02)01173-x
OpenAlex
W2156722534
Cited by
316
References
70
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 3 · 2021: 7 · 2020: 9 · 2019: 9 · 2018: 8 · 2017: 11 · 2016: 9 · 2015: 9 · 2014: 16 · 2013: 22 · 2012: 26
FWCI
3.65
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The American Journal of Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
  • Health Sciences › Medicine › Surgery › Body Contouring and Surgery
  • Health Sciences › Medicine › Surgery › Minimally Invasive Surgical Techniques
Keywords
morbid obesity, bariatric surgery, restrictive practices, malabsorptive surgery, Roux-en-Y gastric bypass, vertical banded gastroplasty, laparoscopic adjustable gastric banding, biliopancreatic diversion, duodenal switch, laparoscopic surgery, weight loss, nutritional complications
MeSH terms
Diet, Reducing, Humans, Obesity, Morbid, Laparoscopy, Gastroplasty, Exercise, Risk Assessment, Anti-Obesity Agents

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