Recent Modalities in the Surgical Management of Morbid Obesity

Abstract

Obesity is considered a major health and socio economic problem. Over weight, obesity and morbid obesity are terms often used to describe individuals with and increased body fat. The most common definition of morbid obesity is a body mass index (BMI) of 40 Kg /m2 or more. More than 250 millions individuals are obese. The aetiology of this condition is multi factors including; familial and genetic predisposition, drug induced obesity, endocrinal causes, childhood over nutrition, intake of food in large quantities and many times in the day, psychological factors, environmental factors, special habits like alcohol consumption and smoking and personal factors like; age, gender, ethinity and parity. Clear understanding of the pathophysiology of morbid obesity is essential for management and prevention of this disaster. There are several factors concerning the occurrence of obesity, the first one in this mechanism is the genetic control also central nervous system control, afferent signals, pattern of feeding, socioeconomic factors, exercise and pattern of distribution of excess adipose tissue, leptin also, have a role in the mechanism of this disease.Leptin is the best known of the afferent fat signals and the best candidate for primary signal communication of body fat information to the central controller. There are many disastrous diseases associated with morbid obesity including; cardiovascular diseases, diabetes mellitus, respiratory problems, digestive diseases, arthritis, chronic abdominal compartmental syndrome, hernia, infectious problems,endocrinal abnormalities, psychological problems, complications associated with pregnancy, cancer, neurological complications and other medical problems compounded by obesity. The goal of weight-loss therapy is to improve health by modifying obesity-related diseases and the risk for future obesity-related medical complications Treatment of morbid obesity may be conservative as medical treatment (behavior modification, diet regimen, exercise and drugs) and active physical interventions (as jaw wiring, gastric balloon, acupuncture and waist cord) or it may be surgical as which may be open as gastric by- pass, intestinal bypass and gastroplasty which divided in to Vertical banded gastroplasty, horizontal gasroplasty, gastric banding and gastric wrap or laparoscopic surgery as laparoscopic vertical banded gastroplasty, laparoscopic adjustable gastric banding, laparoscopic gastric bypass, laparoscopic malabsorpative procedure and laparoscopic bariatric pacing. Surgical treatment seems to be more effective in the management of morbid obesity with acceptable rate of complications. The surgical modalities used in the bariatric surgery initially used in treating other conditions, and these modalities were found to cause weight loss post- operatively as a side effect. It is obvious from the number of procedures practiced that the ideal operation for morbid obesity has not been developed. This is because these producers are accompanied by significant morbidly and mortality that varies between 1 and 5 %. The most common and accepted procedure nowadays is gastric banding. This is because of the preservation of the normal anatomy of the upper gastrointestinal tract and the possibility of reverse of this procedure if the postoperative complications cannot be overcomed. The idea of this technique is the usage of a dacron tube or silicon bands to compartmentalize the stomach into small proximal and large distal segments. It is a pure restrictive technique with the ability to reverse it in any time with un avoided complications.