title: Clinical application of laparoscopic bariatric surgery: an evidence-based review.
abstract: BACKGROUND
  Approximately one-third of U.S. adults are obese. Current evidence suggests that surgical therapies offer the morbidly obese the best hope for substantial and sustainable weight loss, with a resultant reduction in morbidity and mortality. Minimally invasive methods have altered the demand for bariatric procedures. However, no evidence-based clinical reviews yet exist to guide patients and surgeons in selecting the bariatric operation most applicable to a given situation.
  
  
  METHODS
  This evidenced-based review is presented in conjunction with a clinical practice guideline developed by the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). References were reviewed by the authors and graded as to the level of evidence. Recommendations were developed and qualified by the level of supporting evidence available at the time of the associated SAGES guideline publication. The guideline also was reviewed and co-endorsed by the American Society for Metabolic and Bariatric Surgery.
  
  
  RESULTS
  Bariatric surgery is the most effective treatment for severe obesity, producing durable weight loss, improvement of comorbid conditions, and longer life. Patient selection algorithms should favor individual risk-benefit considerations over traditional anthropometric and demographic limits. Bariatric care should be delivered within credentialed multidisciplinary systems. Roux-en-Y gastric bypass (RGB), adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPD + DS) are validated procedures that may be performed laparoscopically. Laparoscopic sleeve gastrectomy (LSG) also is a promising procedure. Comparative data find that procedures with more dramatic clinical benefits carry greater risks, and those offering greater safety and flexibility are associated with less reliable efficacy.
  
  
  CONCLUSIONS
  Laparoscopic RGB, AGB, BPD + DS, and primary LSG have been proved effective. Currently, the choice of operation should be driven by patient and surgeon preferences, as well as by considerations regarding the relative importance placed on discrete outcomes.
authors.affiliation: Department of Surgery, University of North Carolina, Chapel Hill, NC 27599-7081, USA. tfarrell@med.unc.edu
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Farrell
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Haggerty
authors.forename: D Wayne
authors.initials: DW
authors.lastname: Overby
authors.forename: Geoffrey P
authors.initials: GP
authors.lastname: Kohn
authors.forename: William S
authors.initials: WS
authors.lastname: Richardson
authors.forename: Robert D
authors.initials: RD
authors.lastname: Fanelli
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery*; D018579:Patient Selection; D011300:Preoperative Care; D016896:Treatment Outcome