RISK AND BENEFITS OF LAPAROSCOPIC GASTRIC SURGERY IN TREATMENT OF MORBID OBESITY

Abstract

SUMMARY O besity is simply defined as "excessive amount of body fat" and should be considered a chronic disease, as it has definite mortality and morbidity. The most widely accepted measure of obesity is the body mass index (BMI). Morbid obesity is having a BMI greater than 40 kg/m2 or a BMI greater than 35 kg/m2 with concomitant obesity-related morbidity. For the past two decades, we have been living through an epidemic of obesity. This escalation in obesity is a time bomb for the future risk of diabetes and other illnesses and for the attendant costs. Severe obesity has higher rates of morbidity and mortality and decrease quality of life. It is a risk factor for diabetes, hypertension, hyperlipidemia, IHD, and arthritis. Effective weight loss therapy can reverse many of the adverse effects of severe obesity. Available therapies include lifestyle changes (diet and exercise, behavioral changes), pharmacologic therapy, and surgery. Of these, bariatric surgery is documented as the most consistently effective therapeutic intervention for the severely obese. Bariatric surgical procedures can be categorized as malabsorptive, restrictive, or combined. These categories correspond to the bariatric procedures currently in common use. Biliopancreatic diversion (BPD) is malabsorptive, laparoscopic adjustable gastric banding (LAGB), vertical banded gastroplasty (VBG), sleeve gastrectomy and gastric plication are restrictive, Roux-en-Y gastric bypass (RYGB) and BPD with duodenal switch (BPD/DS) combine both malabsorptive and restrictive features. Gastric plication is an emerging new procedure. Laparoscopic bariatric surgery is much better than open surgery due to less liability for postoperative complication (especially wound complication) and shorter hospital stay. LAGB reduce the size of the stomach via silicone inflatable tube encircling small bouch from the stomach and its stoma can be calibrated. This make patient feel early satiety and decrease caloric intake. LRYGB reduce the size of the stomach and shorten the part of the bowel in which the food is digested and absorbed via bypassing the duodenum and part of the jejunum with higher risk of anastomotic leake. VBG reduce the size of the stomach by exclusion of part of the stomach without excision less incidence of leakage but risk of stable line dehiscence with fistula in the fundus and failure of the procedure. Sleeve gastrectomy is an effective procedure that reduces the stomach capacity and decrease ghrelin (ahormone affecting satiety center) via excision of part of the stomach but still has the risk of leakage and fistula formation.