Bariatric Surgery Techniques Research Articles

Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure?

Sleeve gastrectomy (SG) is a restrictive bariatric surgery technique that was first used as part of restrictive horizontal gastrectomy in the original Scopinaro type biliopancreatic diversion. Its good results as a single technique have led to a rise in its use, and it is currently the second most performed technique worldwide. SG achieves clearly better results than other restrictive techniques and is comparable in some aspects to the Roux-en-Y gastric bypass, the current gold standard in bariatric surgery. These benefits have been associated with different pathophysiologic mechanisms unrelated to weight loss such as increased gastric emptying and intestinal transit, and activation of hormonal mechanisms such as increased GLP-1 hormone and decreased ghrelin. The aim of this review was to highlight the salient aspects of SG regarding its historical evolution, pathophysiologic mechanisms, main results, clinical applications and perioperative complications.

Eficácia analgésica do bloqueio ecoguiado do plano transverso do abdome – revisão sistemática

BackgroundThe transverse abdominal plan blockade (TAP) is a block of abdominal wall that has diffused rapidly in the clinical practice as part of a multimodal analgesia for abdominal surgery. The performance of the ultrasound‐guided technique has allowed the lowering of potential complications, as well as new approaches that according to the descriptions carried out and the prospective studies would make it possible to utilize the TAP in different surgical interventions; however, the results obtained in randomized clinical trials (RCTs) are inconsistent. ObjectivesTo prepare a systematic review aiming to determine the efficacy of the ultrasound‐guided TAP for different surgical interventions, as well as the indications according to the approaches and their influences. MethodsTwo research approaches, one manual, and the other in Pubmed returned 28 RCT where an intervention with ultrasound‐guided TAP were performed to compare the analgesic efficacy in contrast to another technique in adults, published between 2007 and October 2013, in English or Spanish, with Jadad score > 1, according to the inclusion criteria for this review. The authors analyzed independently all the RCT. ConclusionsThe TAP have been shown to be an effective technique in colorectal surgery, cesarean section, cholecystectomy, hysterectomy, appendectomy, donor nephrectomy, retropubic prostatectomy, and bariatric surgery. However, the data found in RCT are not conclusive, and as a result, it is necessary to develop new and well designed RCT, with enough statistical power to compare different approaches, drugs, doses, and volumes for the same intervention, aiming to answer the current questions and their effects in the habitual clinical practice.

Analgesic efficacy of the ultrasound-guided blockade of the transversus abdominis plane – a systematic review

BackgroundThe transverse abdominal plan blockade is a block of abdominal wall that has diffused rapidly in the clinical practice as part of a multimodal analgesia for abdominal surgery. The performance of the ultrasound-guided technique has allowed the lowering of potential complications, as well as new approaches that were carried out according to the descriptions, and the prospective studies would make it possible to utilize the transverse abdominal plan blockade in different surgical interventions; however, the results obtained in randomized clinical trials are inconsistent. ObjectivesTo prepare a systematic review aiming to determine the efficacy of the ultrasound-guided transverse abdominal plan blockade for different surgical interventions, as well as the indications according to the approaches and their influences. MethodsTwo research approaches, one manual, and the other in Pubmed returned 28 randomized clinical trials where intervention with ultrasound-guided transverse abdominal plan blockades was performed to compare the analgesic efficacy in contrast to another technique in adults, published between 2007 and October 2013, in English or Spanish, with Jadad score>1, according to the inclusion criteria for this review. The authors analyzed independently all the randomized clinical trials. ConclusionsThe transverse abdominal plan blockades have been shown to be an effective technique in colorectal surgery, cesarean section, cholecystectomy, hysterectomy, appendectomy, donor nephrectomy, retropubic prostatectomy, and bariatric surgery. However, the data found in randomized clinical trial are not conclusive, and as a result, it is necessary to develop new and well designed randomized clinical trial, with enough statistical power to compare different approaches, drugs, doses, and volumes for the same intervention, aiming to answer the current questions and their effects in the habitual clinical practice.

Eficacia analgésica del bloqueo del plano transverso del abdomen ecoguiado-revisión sistemática

BackgroundThe transverse abdominal plan blockade (TAP) is a block of abdominal wall that has diffused rapidly in the clinical practice as part of a multimodal analgesia for abdominal surgery. The performance of the ultrasound-guided technique has allowed the lowering of potential complications, as well as new approaches that according to the descriptions carried out and the prospective studies would make it possible to utilize the TAP in different surgical interventions; however, the results obtained in randomized clinical trials (RCTs) are inconsistent. ObjectivesTo prepare a systematic review aiming to determine the efficacy of the ultrasound-guided TAP for different surgical interventions, as well as the indications according to the approaches and their influences. MethodsTwo research approaches, one manual, and the other in Pubmed returned 28 RCT where intervention with ultrasound-guided TAP were performed to compare the analgesic efficacy in contrast to another technique in adults, published between 2007 and October 2013, in English or Spanish, with Jadad score >1, according to the inclusion criteria for this review. The authors analyzed independently all the RCT. ConclusionsThe TAP have been shown to be an effective technique in colorectal surgery, cesarean section, cholecystectomy, hysterectomy, appendectomy, donor nephrectomy, retropubic prostatectomy, and bariatric surgery. However, the data found in RCT are not conclusive, and as a result, it is necessary to develop new and well designed RCT, with enough statistical power to compare different approaches, drugs, doses, and volumes for the same intervention, aiming to answer the current questions and their effects in the habitual clinical practice.

Is esophagogastroduodenoscopy before Roux-en-Y gastric bypass or sleeve gastrectomy mandatory?

BackgroundRoux-Y Gastric Bypass is a frequently used technique in bariatric surgery. Postoperative anatomy is altered by exclusion of the stomach, which makes this organ inaccessible for future esophagogastroduodenoscopy (EGD). The value of preoperative assessment of the stomach is unclear. Some institutions choose to investigate the future remnant stomach by EGD, others do not. Aim of the present study is to quantify the yield of preoperative EGD in our institution. MethodsPatients, planned for primary laparoscopic Roux-Y Gastric Bypass (LRYGB) or laparoscopic sleeve gastrectomy from December 2007 until August 2012, were screened by EGD in advance. Results of EGD and patient characteristics were retrospectively analyzed and categorized according to a classification system based on intervention needed. Results523 patients (122 male, 401 female, mean age 44.3 years, average BMI 46.6) underwent preoperative EGD. In 257 patients (48.9%) no abnormality was found (group A), 117 patients (17.2%) had abnormalities without treatment consequences (B1), 84 patients (of the 326 tested [comment #1, reviewer #1, 26.8%] were H. Pylori positive (B2), in 75 (14.3%) treatment with proton pump inhibitors was required (B3), 6 (1.1%) required follow up EGD before surgery (C). For1 patient (0.2%) the operation was canceled because preoperative EGD presented with Barrett’s esophagus with carcinoma (D). When all abnormalities were taken into account, baselines did show a significant difference for age, gender and reflux symptoms. ConclusionStandard preoperative assessment by EGD in patients who are planned for bariatric surgery is not indicated. The number needed to screen to find clinically significant abnormalities is high.

Laparoscopic revolution in bariatric surgery.

The history of bariatric surgery is investigational. Dedicated surgeons have continuously sought for an ideal procedure to relieve morbidly obese patients from their burden of comorbid conditions, reduced life expectancy and low quality of life. The ideal procedure must have low complication risk, both in short- and long term, as well as minimal impact on daily life. The revolution of laparoscopic techniques in bariatric surgery is described in this summary. Advances in minimal invasive techniques have contributed to reduced operative time, length of stay, and complications. The development in bariatric surgery has been exceptional, resulting in a dramatic increase of the number of procedures performed world wide during the last decades. Although, a complex bariatric procedure can be performed with operative mortality no greater than cholecystectomy, specific procedure-related complications and other drawbacks must be taken into account. The evolution of laparoscopy will be the legacy of the 21(st) century and at present, day-care surgery and further reduction of the operative trauma is in focus. The impressive effects on comorbid conditions have prompted the adoption of minimal invasive bariatric procedures into the field of metabolic surgery.

Nursing Care in Bariatric Surgery

Obesity is caused by increased amounts of fatty tissue in the body and increasingly common serious health problem. The prevalence of obesity is increasing in all age groups throughout the world. This increase in the rate of obesity increases the incidence of obesity-related chronic diseases. In this respect, obesity is considered a risk factor for the chronic diseases. People who are more than 30 Body Mass Index called as obese and people who are over 40 called morbidly obese. Bariatric surgery is an effective treatment providing in permanent weight loosing for obesity. Bariatric surgery techniques are applied as three different types. These techniques include; limit food intake, reduce nutrient absorption (malabsorption), and restricting food intake and malabsorption surgeries. In bariatric surgery, patient care is becoming increasingly important at before and after surgery due to the presence of concomitant diseases in obese patients. During this period, there are special nursing practices which include reducing the risks in the care of patients who are candidates for bariatric surgery, preventing the development of complications and supplying the recovery from illness as soon as possible. In this article nursing care of obese patients before and after surgery is to be discussed. In addition, bariatric surgery, complications and difficulties in live patients are to be examined

Metabolic and endocrinological factors related to nephrolithiasis pre and post multiple techniques of bariatric surgery: a sistematic review.

IntroductionDespite of benefits of bariatric surgery for obesity treatment, the procedure may be related to some complications.AimAnalyze studies to address the relation between nephrolithiasis and bariatric surgery.MethodsTen papers about this theme were selected from 2005-2013 in Pubmed, describing the relation of nephrolithiasis or their risk factors with several types of bariatric surgery.ResultsRetrospective studies with minimal follow-up of three years demonstrated 7,65% in surgery patients and 4,63% non-surgery with nephrolithiasis (p<0,05). Prospective studies (8 of 10) revealed large percentage of calculi appearing and significant increase in oxaluria.ConclusionThere is correlation between obesity surgery and nephrolithiasis.

Two lessons from a 5-year follow-up study of laparoscopic sleeve gastrectomy: Persistent, relevant weight loss and a short surgical learning curve

Like Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy (LSG) has been validated as a bariatric surgery procedure in its own right. However, the few studies of the long-term outcomes of LSG have only featured small patient populations. The objective of the present study was to evaluate weight loss 5 years after LSG and assess the surgical learning curve for this procedure. We performed a retrospective, single-center study of a prospective database including all consecutive patients having undergone LSG at Amiens University Medical Center between November 2004 and July 2007. Data (weight, body mass index [BMI], percentage of excess weight loss [EWL], percentage of excess BMI loss, and percentage weight loss [PWL]) were collected during follow-up (particularly after 5 years). The study population comprised 118 patients (100 females [85%]; mean ± SD age, 40 ± 11 years; mean preoperative weight, 131 ± 22 kg; mean preoperative BMI, 47.7 ± 7 kg/m(2)). LSG was performed after failure of gastric banding in 23 cases (19%) and after failure of an intragastric balloon in 1 (0.8%). In all, 95 patients (81%) were analyzed ≥60 months after the LSG (mean follow-up period, 71 ± 9 months). The PWL and EWL were 25 ± 14% and 46 ± 26%, respectively. Eleven patients had undergone a second bariatric operation within 5 years of the LSG. Concerning the 84 patients in whom only LSG was the only operation, the PWL and EWL were 23 ± 14% and 43 ± 25%, respectively. The EWL was >50% in 35 of these 84 patients (42%) and between 25 and 50% in 30 cases (36%). Optimal weight results were achieved after only 28 LSG had been performed, which testifies to a shorter learning curve than for most other bariatric surgery techniques. Isolated LSG is a quickly mastered bariatric surgery technique with a short learning curve. It enables a mean PWL of >25% and an EWL of >50% in >40% of cases.

Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials

Objective To quantify the overall effects of bariatric surgery compared with non-surgical treatment for obesity.Design Systematic review and meta-analysis based on a random effects model.Data sources Searches of Medline, Embase,...

Metabolic Surgery for the Treatment of Type 2 Diabetes Mellitus: Safety and Feasibility of Laparoscopic Sleeve Gastrectomy

Abstract Introduction: Type 2 diabetes mellitus (T2DM) and obesity are often associated and represent a complex health problem with debated medical management. Laparoscopic sleeve gastrectomy has gained a great consensus because of its efficacy, and no significant postoperative morbidity. In this report, we describe this relatively recent technique of bariatric surgery. Description of the Video: 00:05—The pneumoperitoneum is performed by Veress needle in the left subcostal region. The optical trocar is positioned at ∼15 cm from the ensiform apophysis on the median. Three trocars of 12 mm were respectively placed on the left pararectal region, right, and right subcostal region, and another trocar of 5 mm was inserted in the left paraumbilical region under laparoscopic vision. 01:20—Marking is performed on the large gastric curve at 6 cm from the pylorus. From this site, there is the progressive skeletrization of the greater curvature with ultrasonic scalpel, and then the sectioning and coagulation of the v...

GLP-1 and the Long-Term Outcome of Type 2 Diabetes Mellitus After Roux-en-Y Gastric Bypass Surgery in Morbidly Obese Subjects

To evaluate the association between glucagon-like peptide 1 (GLP-1) secretion and the long-term (>2 years) outcome of type 2 diabetes mellitus (T2DM) after Roux-en-Y gastric bypass (RYGBP). Cross-sectional study in 18 T2DM morbidly obese subjects who underwent RYGBP but differed in the long-term outcome of T2DM (remission: G1, n = 6; relapse: G2, n = 6; lack of remission: G3: n = 6). Groups were matched for their sex, age, and body mass index. The GLP-1, glucose, C-peptide, and glucagon responses to a standardized test meal (STM) were evaluated. Insulin secretion and insulin sensitivity were estimated from the STM and by frequently sampling intravenous glucose tolerance test (FSIVGTT). Dual-energy X-ray absorptiometry was used to assess body composition. Patients in G1 presented a lower area under the curve (AUC0-120) of glucose in response to the STM as compared with G2, and G3 (P < 0.01). In contrast, the AUC0-120 of GLP-1 (P = 0.884) and glucagon (P = 0.630) did not differ significantly among the 3 groups. Indices of insulin secretion adjusted by the prevailing insulin sensitivity derived from STM and FSIVGTT, demonstrated larger β-cell function in subjects in G1 as compared with G2 or G3 (Disposition Index-STM, P = 0.005; DI-FSIVGTT, P = 0.006). Body composition and inflammatory markers did not differ significantly among the 3 study groups. Our data show that in subjects with T2DM an enhanced GLP-1 response to meal intake is not sufficient to maintain normal glucose tolerance in the long term after RYGBP. Our data suggest that β-cell function is a key determinant of the long-term remission of T2DM after this bariatric surgery technique.

Adjustable Gastric Band as Surgical Treatment for Morbid Obesity. Are Worldwide Results Reproducible in Spain?

IntroductionAdjustable gastric banding is a surgical technique used all over the world for the treatment of morbid obesity. In Spain, the number of patients treated with adjustable gastric banding is far lower than the average worldwide average. A number of reasons have been put forward to explain this difference. Materials and methodsA program of bariatric surgery by means of implantation of an adjustable gastric banding was started in 2001, together with a dedicated follow-up protocol in order to prevent complications and improve results. ResultsA total of 132 patients were operated on between 2001 and 2011. The mean age of the 102 female and 30 male patients was 39 years, and the mean body mass index was 43. Follow-up was longer than 5 years in 61 patients, while the mean follow-up in the rest was 44.4 months. There was no mortality or severe morbidity. Eight patients (6.06%) underwent reoperation, 3 of them for complications related to the reservoir, 4 for slipping of the band, and one for erosion. One slipped band was removed, and a new one (of the Lap Band type) was inserted. Three slipping bands were converted to other techniques. The percentage excessive body weight loss was maintained in 54.8% of the patients followed-up for longer than 5 years. ConclusionsThe results of our series are comparable to those reported in the literature and show that, provided that a close follow-up, like that performed by most groups, is implemented, adjustable gastric banding can also be a safe and effective bariatric surgery technique in our country.

La banda gástrica ajustable como tratamiento de la obesidad mórbida: ¿son reproducibles los resultados mundiales en España? Análisis de 132 pacientes intervenidos en los últimos 10 años

IntroductionAdjustable gastric banding is a surgical technique used all over the world for the treatment of morbid obesity. In Spain, the number of patients treated with adjustable gastric banding is far lower than the average worldwide average. A number of reasons have been put forward to explain this difference. Material and methodsA program of bariatric surgery by means of implantation of an adjustable gastric banding was started in 2001, together with a dedicated follow-up protocol in order to prevent complications and improve results. ResultsA total of 132 patients were operated on between 2001 and 2011. The mean age of the 102 female and 30 male patients was 39 years, and the mean body mass index was 43. Follow-up was longer than 5 years in 61 patients, while the mean follow-up in the rest was 44.4 months. There was no mortality or severe morbidity. Eight patients (6.06%) underwent reoperation, 3 of them for complications related to the reservoir, 4 for slipping of the band, and one for erosion. One slipped band was removed, and a new one (of the Lap Band type) was inserted. Three slipping bands were converted to other techniques. The percentage excessive body weight loss was maintained in 54.8% of the patients followed-up for longer than 5 years. ConclusionsThe results of our series are comparable to those reported in the literature and show that, provided that a close follow-up, like that performed by most groups, is implemented, adjustable gastric banding can also be a safe and effective bariatric surgery technique in our country.

Laparoscopic Sleeve Gastrectomy and Medical Management for the Treatment of Type 2 Diabetes Mellitus in Non-Morbidly Obese Patients: A Single-Center Experience

Type 2 diabetes mellitus (T2DM) and obesity are often associated in the same metabolic pathology and represent a significant public health problem. Although laparoscopic sleeve gastrectomy (LSG) is a relatively recent technique of bariatric surgery, it has shown to be efficient and safe and has obtained much support from physicians and patients. Several studies have highlighted the effects in terms of resolution and improvement of diabetes. From January 2009 to November 2012, 15 patients in Obesity Class II (body mass index [BMI], 37.9 ± 1.5 kg/m(2); baseline weight, 102.7 ± 11.6 kg) with uncontrolled T2DM despite taking a glucose-lowering drug therapy (glycated hemoglobin [HbA1c], 8.1 ± 0.6%) underwent LSG and advanced practice medical management in accordance with the American Diabetes Association guidelines. All patients were subjected to follow-up controls with anthropometric and metabolic indices at 5, 15, 30, and 60 days, and at 6 and 12 months after surgery, remission of diabetes was also evaluated. At 1 year after surgery, the mean excess weight loss percentage (EWL%) was 58.4%, and the mean BMI had decreased from the preoperative value of 37.9 kg/m(2) to 30.4 kg/m(2). The average reduction in HbA1c was 2.5 (30.9%). The mean homeostatic model assessment of insulin resistance decreased from 13.3 to 4.9. Overall, during the period of observation, four patients (26.7%) had started drug therapy again, six patients had complete remission (40%), and five patients had partial remission (33.3%). LSG not only makes it possible to attain a significant EWL% in obese patients, but also a remission or improvement of diabetes. Further studies are required to determine the duration of the effect and the role of different factors involved.

Gastric Banding Reduces Weight through Ghrelin and Adiponectin Plasma Concentration in Obese Rat Models

Obesity is caused by an imbalance of food intake and body expenditure. Obesity is often defined as a condition of abnormal or excess fat in adipose tissue that seriously damages the health. A national survey conducted in 2009 showed that from all provincial capitals in Indonesia, 8.1% of adult males (≥ 18 years) were overweight (BMI 25-27) and 6.8% were obese, 10.5% of females adults were overweight and 13.5% were obese. In the group age of 40-49 years, overweight or obese reached its peak of 24.4% and 23% in men, 30.4% and 43% in women. From body Mass Index 23.0 to 24.9, obese I (25.0 to 29.0) and obese II (≥ 30) indicate the risk of metabolic syndrome in Indonesian people and LAGB procedure should be considered. On the obesity condition, ghrelin and adiponectin decrease. On previous studies, it is known that there is a relationship between adiponectin, glucose, insulin, lipid parameters in both overweight / obese women and men. Ghrelin is secreted by the stomach into the blood circulation. Treatment of obesity can be done with diet regulation strategies, behavior, drugs and physical exercise, but the success rate is still low. Bariatric surgery technique was developed and has been known to reduce obesity by about 30%. The success of bariatric surgery in obesity is to lose weight about 20-40 kg of initial body weight and BMI reduction of about 10-15 kg/m2. The purpose of this study was to determine the influence of gastric banding (GB) on weight loss through an increase in ghrelin and adiponectin. The research was carried out in vivo in obese mice models by means of a purely experimental research conducted in the laboratory with a factorial design. This study examines the influence of gastric banding (GB)factors, and time(duration) against the dependent variable. Ghrelin and adiponectin levels were measured in plasma by ELISA method.There is a decrease in weight of about 27.87% on day 8 and 38.87% on day 16 after GB. The results of statistical analysis showed that theweight loss percentage decreasedsignificantly (p = 0.0001). An increase in ghrelin and adiponectin levels were measured on days 0, 8, and 16. After receiving treatment, the ghrelin serum in the GB group is higher and it has a stable value over the control group. The results of pathway analysis showed that the GB indirectly affects body weight through ghrelin and adiponectin. Gastric banding affects the weight loss through an increase in ghrelin and adiponectin. Gastric banding not only reduces obesity, but also fixes adiposopathy through the increased adiponectin in obese mice models. Time (duration) of GB is associated with weight loss through the increased ghrelin and adiponectin levels.

Liver failure in an obese middle-aged woman after biliointestinal bypass

Obesity is considered an emerging epidemic that is often associated with non-alcoholic fatty liver disease. Among the therapeutic options for morbid obesity, bariatric surgery plays an important role when conventional therapies fail. The effects of bariatric surgery on liver function and morphology are controversial in the literature. Liver failure has been reported after jejunoileal bypass (JIB), biliopancreatic diversion and gastric bypass. Biliointestinal bypass (BIB) is considered an effective procedure among recently introduced bariatric surgery techniques. It is a clinically safe, purely malabsorptive operation in which the blind intestinal loop of the JIB is anastomosed to the gallbladder, allowing a portion of bile to transit into excluded intestinal tract. BIB is the only procedure, to our knowledge, to have no liver side effects reported in the literature. We report the case of a young obese woman who developed liver failure 8 mo after BIB. She had a rapid weight loss (70 kg) with a reduction in body mass index of 41% from January to September 2012. Because of a severe hepatic decompensation, she was referred to a transplantation centre. We strongly believe that the most important pathogenetic mechanism involved in the development of liver injury is the rapid weight loss that produced a significant fatty liver infiltration.

Impact de la chirurgie bariatrique sur le pronostic obstétrical

ObjectivesAssessment of pregnancy outcomes after bariatric surgery and analysis of follow-up particularities of such pregnancies. Patients and methodsA retrospective study of 63 post-bariatric surgery pregnancies compared to 259 pregnancies of obese un-operated patients. Pregnancy outcomes, neonatal datas, delay influence between surgery and pregnancy beginning, bariatric surgery type and gastric banding (GB) loosening consequences were analysed. ResultsIn the surgical brand were developed less gestational diabetes (DG) (P=0,05), deliveries were more often normal (P=0,004) and births shown less macrosomias and small for gestational age newborns (P=0,04). Neonatal state was improved among operated patients: less Apgar scores less than 7 at 1minute (P=0,05) and less cord blood pH less than 7,2 (P=0,03). They gained more weight during the pregnancy (P=0,0003) and only 53% had a nutritional management and assessment. Patients with GB loosening gained more weight (P=0,0003). Lastly, there were no difference due to the different bariatric surgery techniques or nutritional follow-up in the pregnancy course and neonatal state. Discussion and conclusionBariatric surgery improves obstetric and neonatal prognosis. Improvements have to be developed in the multidisciplinary follow-up in order to avoid nutritional deficiencies or important weight gain pregnancy in case of GB.

Duodenal switch: a comprehensive view of a biliopancreatic diversion in metabolic surgery

The duodenal switch is a technique of Bariatric Surgery that modifies the Scopinaro biliopancreatic diversion, described by Hess and Marceaux in 1988, supported by the original description that made De Meester for the treatment of gastroesophageal reflux recurrent disease. It is a complex technique, probably the most laborious of all bariatric procedures until now known, which can and must be done by laparoscopy and consisting of several surgical steps. It involves the performance of a vertical gastrectomy with bougies of different diameter and a bypass Roux-en-Y into the duodenum, with different lengths limbs. Duodenoileal anastomosis is the most difficult and different techniques are described. It must be accompanied by closure of the defects and in most of the cases of an appendectomy and cholecystectomy. There have been greater than the gastric bypass Roux-en-Y in operating time, hospitalization, morbidity and mortality. Reported complications are up a 24% of the cases, early or late, these are metabolic one and easily controllable, so a good index of satisfaction with low percentage of review and no more than 1.5% mortality. Achieved a decrease of 70% of excess weight in the long term, with improvement in all co-morbidities reaching around a 95% diabetes and metabolic control of the dyslipidemias. Given the good results it should be seen as a technique of choice for the treatment of the obese patient with metabolical disorder.

Técnicas em cirurgia bariátrica: uma revisão da literatura

Introduction: Obesity is a chronic medical condition of multifactorial etiology whose failure in clinical and therapeutic treatment leads to the need of more effective intervention, the surgical procedure. The bariatric surgeries may only change the stomach in order to reduce the space for the food and promote the feeling of fullness, or in addition may change the small intestine, in order to place a decrease in absorption of nutrients. Objective: To review the intervention techniques in bariatric surgery, in order to understand the reasons why surgeons choose a specific technique. Materials and Methods: We conducted an exploratory study trough a bibliographic review in SciELO, LILACS, PubMed and BIREME databases, under the following indexes: bariatric surgery techniques, biliopancreatic diversion, vertical banded gastroplasty, adjustable gastric band, vertical gastrectomy, gastric bypass surgery, Roux-en-Y gastric bypass, sleeve gastrectomy with duodenal switch. Results: From 66 references related to techniques in bariatric surgery analyzed, 40 were selected among bibliographic work chapters, consensus, systematic reviews, meta-analysis, randomized and controlled clinical trials. We reviewed the surgical techniques for the treatment of obesity classified as restrictive, predominantly restrictive and poorly absorptive. Conclusions: Currently, different surgical techniques in the treatment of obesity are recognized and recommended worldwide. The surgeon´s choice for a technique will be based on information about its mechanism, performance and risks that can be found on relevant scientific publications.