Traitement chirurgical de l'obésité

France holds the second rank, behind USA, in obesity surgery. More than 8000 adjustable gastric banding procedures are achieved each year in France; More than 2000 bypass procedures and 500 sleeve gastrectomies are performed, either. Banding obtains 55% at two years mean excess weight loss. Gastric bypass usually allows 75% at 2 years loss, while sleeve gastrectomy gets a 60% at 1 year. Post-operative mortality is 0.14% after gastric banding and 0.6% after bypass. Morbidity related with banding is 4%, consisting in gastric or oesophageal perforation, early displacement of the device, pneumopathies and pulmonary embolism. Morbidity rate after bypass is 10% : leak and fistulae, haemorrhage, adhesive obstruction, pulmonary embolism, pneumopathy, rhabdomyolysis. Vertical sleeve gastrectomy morbidity is evaluated in 5%, essentially fistulae, subphrenic abscess, bleeding, pneumopathies and pulmonary embolism. Eleven percent adjustable banding patients are subjected to late complications, and 8% of them require reoperation, mostly due to intragastric migration, device displacement with gastric pouch dilation, oesophagus dilation, tube and subcutaneous port related problems. Bypass carries an 8% long term complication rate: anastomotic ulcer (medical treatment), gastro-jejunostomy stenosis (endoscopic dilation), adhesive obstruction, nutritional disorder with severe vitaminic deficiency. Sleeve gastrectomy has no known long term complication. While US surgeons often recommend gastric bypass as first intention procedure, surgical strategy is more moderated and vary according to patient's BMI. Adjustable banding is mainly chosen whenever BMI does not exceed 50 kg/m2. In case of BMI exceeding 50 kg/m2, some surgeons would perform a gastric bypass, while others prefer sleeve gastrectomy.