Laparoscopic Surgery for Morbid Obesity

Morbid obesity is a fast growing epidemic worldwide. Apart from affecting 25–35% adult population in the western hemisphere, similar patterns have been noted in the pediatric and adolescent population. It causes a myriad of physical, social and psychological disorders apart from actually decreasing the life expectancy. Medical treatment invariably fails to sustain lost weight in the long term in patients with morbid obesity (BMI of above 40). Laparoscopic surgery is the only effective long-term solution for morbid obesity and requires lifestyle and behaiour changes for optimal results. Laparoscopic surgery may be either restrictive alone (laparoscopic gastric banding), restrictive and mal-absorptive (Laparoscopic roux-en-Y gastric bypass) or primarily mal-absorptive (duodenal switch) and is designed to tailor different BMI's. Patients with higher BMI (>45) or higher age group (>50 years age) with restricted activity will benefit more from gastric bypass while younger patients who are compliant and can increase activity can be offered lap band procedure. Laparoscopic gastric bypass can produce more weight loss (>75% of excess body weight) in a shorter time (one and a half years) and is a one time procedure but has higher incidence of complications like leak or haemorrhage. Laparoscopic gastric banding requires repeated adjustments and can lead to 50–55% excess body weight loss in two to two and half years. The main advantage of gastric banding is safely, simplicity, adjustability and reversibility. At Indraprastha Apollo Hospitals, New Delhi, we have performed 15 bariatric procedures (13 laparoscopic adjustable gastric banding and two laparoscopic gastric bypasses) over the past eight months with very promising initial results.