Surgical Treatment of Obesity: An Asian Perspective

Today, bariatric surgery, as the only effective therapy for morbid obesity, is expanding exponentially to meet the global epidemic of obesity. There is increasing evidence that effective long-term weight loss is achieved after bariatric surgery. A substantial majority of patients with diabetes, hyperlipidemia, hypertension and obstructive sleep apnea have experienced complete resolution or improvement with significant survival benefits. Patients with a body mass index (BMI) > 35.0 kg/m2 and comorbidities, or Asian people with a BMI of 32.0 kg/m2 and diabetes mellitus can be candidates for weight-reducing surgery. Currently, laparoscopic adjustable gastric banding (LAGB) and laparoscopic gastric bypass (LGB) are two commonly used procedures in weight-reducing surgery. LAGB, a purely restrictive method, is the safest procedure. LGB, a mixed type procedure, is more effective but technically more demanding and carries a higher risk. Laparoscopic sleeve gastrectomy is a new procedure for high-risk or lower BMI patients. Biliopancreatic diversion or duodenal switch, a malabsorption procedure, is used as a second-line operation. The survival benefits of bariatric surgeries rely heavily on their safety. Unlike other gastrointestinal operations performed by general surgeons, bariatric surgery requires a team approach in a center of excellence. The surgeon requires training in advanced laparoscopic techniques and also in the care of the bariatric patient. How safe laparoscopic bariatric surgery can be provided to meet the soaring demand from morbidly obese Asian patients will be an important issue in the near future. [Tzu Chi Med J 2007;19(4):200–206]