SURGICAL-TREATMENT FOR MORBID-OBESITY

Since severe obesity is frequently associated with serious metabolic, cardiovascular and psychological co-morbid conditions, and given the u sually unsuccessful results of conservative therapeutic approaches, su rgical treatment based on gastric restriction procedures is increasing ly recognized as a treatment of choice for morbidly obese persons. Amo ng several surgical approaches designed to promote a substantial loss of weight, two gastric restriction procedures, i.e. the vertical bande d gastroplasty and the gastric bypass, have been increasingly used dur ing the past years. Both techniques induce an impressive loss of weigh t, and are surprisingly well tolerated, even by severely obese persons . The usual 50-75% reduction of initial weight excess, is followed by a clear-cut reduction, or even disappearance of, obesity-related co-mo rbidity, such as hypertension, diabetes mellitus or sleep apnea syndro me. While serious peri- and postoperative risks ore very limited, the intractable vomiting occurring after gastroplasty, and potential seque lae related to iron and calcium malabsorption after the gastric bypass , represent much more frequent complications of the surgical treatment of obesity There is also a tendency towards a late regain of weight, but the benefit in terms of improvement in the obesity-associated co-m orbidity is in general maintained despite this partial increase in wei ght. Gastric procedures are, therefore, on effective treatment of seve re obesity and of its co-morbid conditions. However, careful medical a nd nutritional supervision is necessary during the follow-up after sur gery, to prevent potential nutritional or digestive complications.