title: Changing trends in bariatric surgery.
abstract: OBJECTIVE
  Bariatric surgery is considered the only long-lasting treatment for morbid obesity. Techniques and procedures have changed dramatically. We report on some of the major changes in the field.
  
  
  METHODS
  We reviewed some of the major changes in trends in bariatric surgery based on some landmark paper published in the literature.
  
  
  RESULTS
  We identified three major phases in the evolution of bariatric surgery. The pioneer phase was mostly characterized by discovery of weight loss procedures serendipitously from procedures done for other purposes. The second phase can be identified with the advent of laparoscopic techniques. This is considered the phase of greatest expansion of bariatric surgery. The metabolic phase derives from the improved understanding of the mechanisms of actions of the bariatric operations at the hormonal and molecular level.
  
  
  CONCLUSIONS
  Bariatric surgery has changed significantly over the years. The safety of the laparoscopic approach, along with the better understanding of the metabolic changes obtained postoperatively, has led to a more individualized approach and also an attempt to expand the indications for these procedures.
authors.affiliation: The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: E
authors.initials: E
authors.lastname: Lo Menzo
authors.affiliation: The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Szomstein
authors.affiliation: The Bariatric & Metabolic Institute, Section of Minimally Invasive Surgery, Department of General Surgery, Cleveland Clinic Florida, Weston, FL, USA rosentr@ccf.org.
authors.forename: R J
authors.initials: RJ
authors.lastname: Rosenthal
mesh_terms: D050110:Bariatric Surgery / Q000639:trends*; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000378:metabolism / Q000601:surgery*
keywords: Bariatric surgery; gastric bypass; laparoscopy; metabolic surgery; sleeve gastrectomy; trends