Surgical treatment of morbid obesity: role of the gastroenterologist.
OBJECTIVE
Obesity is an increasing medical problem with associated disorders such as type 2 diabetes mellitus, cardiovascular disorders and many others. The chance to develop co-morbidity is related to the body mass index (BMI) (weight in kg divided by height in metres2) and increases exponentially when the BMI is above 40 (morbid obesity). Permanently effective treatment of morbid obesity is necessary to prevent the development of co-morbidities and to improve the life expectancy of these patients. To date, surgical intervention is the only treatment that can provide the required long-lasting reduction of the excess weight.


CONCLUSIONS
Two types of surgical intervention are currently used, restrictive (including vertical banded gastroplasty (VBG) and adjustable gastric banding) and malabsorptive procedures (gastric bypass, biliopancreatic diversion (BPD)). These interventions effectively reduce weight, with on average a permanent reduction of the excess weight by 60% after gastric restrictive procedures. However, long-term follow-up has shown that up to 30-40% of patients require additional surgical interventions to maintain the acquired weight loss. Long-term failures are dependent on the primary intervention. After VBG the most common problems are occlusion of the outlet by a foreign body, vertical staple line disruption, band stenosis and band erosion. For the adjustable silicone gastric band outlet problems similar to the VBG, band erosion and particularly pouch dilation or slippage have been reported. Failure of the gastric bypass are mainly due to stenosis of the gastro-jejunostomy and stoma ulcers, whereas BPD mainly has metabolic long-term complications.


CONCLUSIONS
The gastroenterologist has an important role in the diagnosis (stoma stenosis, band erosion, staple line disruption, foreign body) and treatment (dilatation, removal of foreign body) of the complications associated with surgical procedures for morbid obesity. In light of the increasing number of procedures performed, a basic knowledge of the currently used techniques and the associated complications is important.
Dept. of Surgery, University Hospital Maastricht, P. O. Box 5800, 6202 AZ Maastricht, The Netherlands. jgre@shee.azm.nl
J W
JW
Greve
D015390:Gastric Bypass / Q000379:methods*; D005762:Gastroenterology / Q000379:methods; D015391:Gastroplasty / Q000379:methods*; D005773:Gastroscopy; D006801:Humans; D009767:Obesity, Morbid / Q000601:surgery*; D010819:Physician's Role; D011183:Postoperative Complications; D011379:Prognosis