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Executive Director, International Federation for the Surgery of Obesity, Toronto, CANADA (M.D.)
Associate Professor of Surgery, Tufts University Medical School, Surgical Director of Obesity Consult Center, New England Medical Center, Boston, MA (S.A.S.)
Address reprint requests to: Dr. M. Deitel, Obesity Surgery, 3100 Bayview Avenue, Unit 4, Toronto, ON M2N 5L3, CANADA. E-mail: medicine{at}sympatico.ca
Morbid obesity is defined as obesity with a body mass index 
40, or 35 with secondary serious diseases. Conservative medical therapies in these individuals generally fail to sustain weight loss. Thus, surgical operations have evolved which are based on gastric restriction and/or malabsorption. Historically, the intestinal bypass operation was followed by the gastric bypass operation (in some instances combined with intestinal bypass) or by the gastric restriction operations (gastroplasty or gastric banding). Laparoscopic techniques are now being used for these operations, but require surgical expertise in both the bariatric operations and advanced laparoscopic skills. All operations may have complications, but these occur in a very small percent. Postoperative follow-up and nutritional surveillance are mandatory. The operations result in significant weight loss, and the current operations have a mean lasting weight loss of about 50 percent of excess body weight, with improvement or resolution of most obesity-associated conditions. There is evidence that even modest to moderate weight loss in these individuals has significant medical benefit.
Key words: morbid obesity, bariatric surgery, intestinal bypass, gastroplasty, gastric bypass, gastric banding, surgical technique, laparoscopy
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