Sleeve Gastrectomy in Surgical Management of Morbid Obesity (Effect, Advantage and Complication)

Abstract

Obesity is simply defined as "excessive amount of body fat" and should be considered a chronic disease, as it has definite mortality and morbidity. The lack of direct methods has led to development of various models and indirect methods for estimation of fat and fat-free mass, all of which are imperfect and require a number of assumptions. The most widely accepted measure of obesity is the body mass index (BMI) which equals patient weight in kilograms divided by the square of his or her height in meters. Morbid obesity is having a BMI greater than 40 kg/m2 or a BMI greater than 35 kg/m2 with concomitant obesity-related morbidity. Appetite is influenced by many factors that are integrated by the brain, most importantly within hypothalamus. Signals that impinge on the hypothalamic centre include neural afferents, hormones and metabolites. The incidence of obesity is steadily rising. Morbid obesity is associated with a large number of problems. Several of these problems are underlying causes for the earlier mortality associated with obesity and include; coronary artery disease, hypertension, impaired cardiac function, adult onset diabetes mellitus, venous stasis and hypercoagulability leading to an increased risk of pulmonary embolism, increased risk of uterine, breast and colon cancer and necrotizing panniculitis. The primary goal of treatment is to improve obesity related co-morbid conditions and reduce the risk of developing future co-morbidities. Treatment of morbid obesity should begin with simple lifestyle changes, including moderation of diet and initiation of regular exercise such as walking. The treatment of associated co-morbidities should be addressed expeditiously. Adjuvant pharmacologic treatments should be considered for patients with a BMI >30 kg/m2 or with a BMI >27 kg/m2 who also have concomitant obesity-related diseases and for whom dietary and physical activity therapy has not been successful. However, because the only effective treatment for morbid obesity is bariatric surgery, these are the initial steps to be taken in preparation for the more definitive treatment. Bariatric surgery offers the only means of delivering sustained weight loss.