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Abstract
Morbid obesity has become a major health concern all over the world, its pathogenesis is complex, but recently focused on genetic causes since the identification of the ob-gene and its protein product leptin (Moulel, 2005).
The increasing prevalence of obesity over the last few years with its known associated several chronic diseases including physical, emotional, and social problems make morbid obesity the biggest independent risk factor for early mortality (Nehoda et al., 2005).
Although medical management of morbid obesity patients made some progress (e.g. xenical), however, a persistent weight reduction can hardly be achieved in these patients. For extreme cases of obesity, only surgical intervention can produce substantial weight loss (Weber, 2003).
Bariatric surgery has included a large number of operative procedures, some of which have become extinct e.g.: JIB, while others continue to be performed successfully (de Csepel et al., 2003). The most commonly used surgical procedures are:
• Gastric restriction procedures, e.g. vertical banded gastroplasty (VBG) and gastric banding (GB) (Doherty, 2001).
• Combined gastric restriction and dumping physiology e.g. Roux-en-Y gastric bypass (RYGB) (Brolin et al., 2001).
• Selective maldigestion and malabsoprtion with partial gastric restriction e.g. partial biliopancreatic bypass with gastrectomy or duodenal switch (Marceau et al., 2001).
Surgery is only one part of a long term multidisciplinary approach that should include a plan for lifelong follow up, including monitoring for nutritional and metabolic complication and dietary counseling to prevent weight gain (Choban et al., 2002).
Complication rate following bariatric surgery is generally low. These procedures, for the most part is completely elective, patients expected to do well with no adverse sequelae. However, it may fail for functional or technical reasons, mostly in inexperienced hands causing inadequate weight loss or severe complications (Byrne, 2001).
The most common morbidities reported with bariatric surgery include early complications, e.g. DVT (2%), pulmonary embolism (1.2%), gastrointestinal leak (1.2% in RYGB), wound infection (1-3 %). Late complications include incisional hernia (15-20% in open procedures), gall stones (up to 50%), stomal stenosis, vomiting (12%), nutritional complications, inadequate weight loss and others (Byrne, 2001).
A minority of these complications occasionally require re-operation. The indication for re-operation dictates the methods of approach, this include revision of the primary procedure for failure to achieve or maintain an adequate weight loss e.g. restapling a VBG or converting it to RYGB.