Bariatric surgery: a primer.
OBJECTIVE
To review the management of bariatric surgical patients.


METHODS
MEDLINE, EMBASE, and Cochrane Library databases were searched, as well as PubMed US National Library, from January 1950 to December 2009. Evidence was levels I, II, and III.


RESULTS
Bariatric surgery should be considered for obese patients at high risk of morbidity and mortality who have not achieved adequate weight loss with lifestyle and medical management and who are suffering from the complications of obesity. Bariatric surgery can result in substantial weight loss, resolution of comorbid conditions, and improved quality of life. The patient's weight-loss history; his or her personal accountability, responsibility, and comprehension; and the acceptable level of risk must be taken into account. Complications include technical failure, bleeding, abdominal pain, nausea or vomiting, excess loose skin, bowel obstruction, ulcers, and anastomotic stricture. Lifelong monitoring by a multidisciplinary team is essential.


CONCLUSIONS
Limited long-term success of behavioural and pharmacologic therapies in severe obesity has led to renewed interest in bariatric surgery. Success with bariatric surgery is more likely when multidisciplinary care providers, in conjunction with primary care providers, assess, treat, monitor, and evaluate patients before and after surgery. Family physicians will play a critical role in counseling patients about bariatric surgery and will need to develop skills in managing these patients in the long-term.
Karmali
Shahzeer
S
Department of Surgery, University of Alberta, 405 CSC, 10240 Kingsway Ave, Edmonton, AB T5H 3V9. shahzeer@ualberta.ca
Johnson Stoklossa
Carlene
C
Sharma
Arya
A
Stadnyk
Janet
J
Christiansen
Sandra
S
Cottreau
Danielle
D
Birch
Daniel W
DW
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods / Q000592:standards; D004608:Eligibility Determination / Q000592:standards; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009767:Obesity, Morbid / Q000401:mortality / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000592:standards; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D012307:Risk Factors; D016896:Treatment Outcome; D015431:Weight Loss; D055815:Young Adult