Introduction

Medical treatment for obesity and the prevention of obesity are, in most cases, discouraging and frustrating for subjects, doctors and dieticians. The surgical treatment of obesity (‘bariatric surgery’) was proposed 40 years ago after it was observed that those who had large portions of the stomach and/or small intestine removed during surgery for gastro-duodenal ulcers or cancer, tended to lose weight postoperatively.

The first operations attempted were intestinal by-pass operations which induced weight loss through gastrointestinal malabsorption. The problems were that intestinal by-pass also produced loss of essential nutrients. Side effects were thus unpredictable and sometimes fatal. As a result, the original intestinal by-pass operations are no longer used. Since these original operations, various other surgical techniques for treating obesity have been proposed and tested. These are predominantly of two kinds: plastic surgery and gastrointestinal surgery.

Surgical techniques and their complications

Plastic surgery in obesity

The two main techniques of aesthetic plastic surgery are liposuction and the surgical resection of fat tissue and redundant skin, particularly that around the abdomen (abdominoplasty) and around the breasts (mastoplasty). There is little comment on the use of these techniques in childhood and they are certainly rarely used in the young.

Gastrointestinal bariatric surgery in adults

Gastrointestinal bariatric surgery follows two different strategies: reducing food intake by gastrorestrictive operations (gastric banding: GB, with or without vertical gastroplasty: VGP) or reducing intestinal absorption by gastrointestinal by-pass (Roux-en-Y gastric by-pass: RYGB, or biliary–pancreatic diversion: BPD).