Surgical treatment of morbid obesity: Role of the gastroenterologist

Aim: Obesity is an increasing medical problem with associated disorders suc h as type 2 diabetes mellitus, cardiovascular disorders and many others. Th e chance to develop co-morbidity is related to the body mass index (BMI) (w eight in kg divided by height in metres(2)) and increases exponentially whe n the BMI is above 40 (morbid obesity). Permanently effective treatment of morbid obesity is necessary to prevent the development of co-morbidities an d to improve the life expectancy of these patients. To date, surgical inter vention is the only treatment that can provide the required long-lasting re duction of the excess weight. Discussion: Two types of surgical interventio n are currently used, restrictive (including vertical banded gastroplasty ( VBG) and adjustable gastric banding) and malabsorptive procedures (gastric bypass, biliopancreatic diversion (BPD)). These interventions effectively r educe 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 interventi ons to maintain the acquired weight loss. Long-term failures are dependent on the primary intervention. After VBG the most common problems are occlusi on of the outlet by a foreign body, vertical staple line disruption, band s tenosis and band erosion. For the adjustable silicone gastric band outlet p roblems 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. Conclusion: The gastroenterologist h as an important role in the diagnosis (stoma stenosis, band erosion, staple line disruption, foreign body) and treatment (dilatation, removal of forei gn body) of the complications associated with surgical procedures for morbi d obesity. In light of the increasing number of procedures performed, a bas ic knowledge of the currently used techniques and the associated complicati ons is important.