LIPOSUCTION — Although not generally considered to be a bariatric procedure, removal of fat by aspiration after injection of physiologic saline has been used to remove and contour subcutaneous fat. While this can result in reduction in fat mass and weight, the amount of weight loss is insignificant in comparison with bariatric procedures and it does not appear to improve insulin sensitivity or risk factors for coronary heart disease [84]. (See "Overview of therapy for obesity in adults", section on Liposuction).

SUMMARY AND RECOMMENDATIONS — Obesity is a major health problem in the United States and its incidence is increasing rapidly. Severe obesity leads to nu****us medical problems and a shortened life expectancy.

Non-surgical treatments for the morbidly obese are rarely effective. Surgical therapies are based primarily on two main mechanisms: restriction of caloric intake via a small stomach reservoir and malabsorption of nutrients via shortened functional small bowel length. All bariatric procedures are effective in achieving weight loss and improving the associated comorbidities in the morbidly obese. Restrictive procedures are generally simpler in techniques but seem to achieve less weight loss. Malabsorptive procedures are highly effective in weight loss but carry significant metabolic complications.

Roux-en-Y gastric bypass is the most commonly performed procedure in the United States due to its multiple mechanisms of action and proven success in long term weight loss.
Laparoscopic RYGB performed by well-trained bariatric surgeons can lower surgical pain, infectious and hernia complications, as well as allowing for quicker postoperative recovery.
Laparoscopic adjustable gastric banding is relatively new in the United States but may become more popular due to its simplicity in technique, adjustability, reversibility, and exceedingly small mortality.
Indications and contraindications for bariatric surgery are described above. (See "Indications" above).

Complications of these procedures are discussed separately. (See "Complications of bariatric surgery").

Clinical practice guidelines from the American College of Physicians for management of obesity in primary care are discussed elsewhere. (See "Overview of therapy for obesity in adults", section on Practice guidelines).


د.نبيل