Role of Surgical Laparoscopy in the Management of Morbid Obesity

Abstract

Morbid obesity is now an important problem all over the world due to its multiple co-morbidities and its marked harmful effect on the lifestyle of the patient. Surgical treatment for obesity has proved that it is the best and most effective, durable means of preventing the life-threatening complications and serious problems associated with morbid obesity. It is indicated by the ineffectiveness of non-surgical treatment methods and the high risk resulting from untreated obesity. Safe, effective surgical treatment methods increase life expectancy and quality of life for patients with extreme excess weight. The sickest ones are the ones who benefit the most, but they are also the highest risk. Operations for massive obesity have developed over the last 40 years, based on malabsorption or gastric restriction, or a combination of both. These operations are being extended into the laparoscopic realm. SG is a feasible and safe bariatric surgery procedure for morbid obesity, although evaluation of long-term outcome will be necessary to determine whether it yields durable results. We believe LSG is a safe and effective one-stage restrictive procedure in the short term to achieve weight loss as a primary procedure in the morbidly obese. In our experience, primary LSG is associated with an acceptable operative time, intraoperative blood loss, and perioperative morbidity, with no mortality and with high patient satisfaction. Prospective studies are required to evaluate the long-term outcome after LSG, specifically effective weight loss, maintenance of weight loss, resolution of co-morbidity, and the potential for gastric tube dilation with weight regain. Also prospective studies are needed to assess the neurohormonal consequences of such procedure. In conclusion, sleeve gastrectomy could be an alternative bariatric operation, easy to perform, safe, with less complications than other bariatric operations. However, further technical studies must be performed and long-term follow-up is awaited. To help ensure good results, each candidate for this surgery must be carefully evaluated on individual basis by a multidisciplinary team, be determined to improve his or her health, and be committed to life-long follow-up.