Obesity is a chronic disease associated with the excessive fat accumulation. Due to its common occurrence and continuous increase in the prevalence worldwide it has been recognized as the epidemic of the 21st century by WHO. Diet, physical activity and pharmacological treatment are an alterative for surgical treatment, although they are often ineffective in achieving significant, long-term weight loss in case of morbid obesity.
Indications for surgical treatment of obesity include:
- Body mass index (BMI) ≥ 40 kg/m2
- Body mass index (BMI) 35–40 kg/m2 with obesity – related diseases such as:
– type 2 diabetes mellitus;
– hypertension;
– cardiovascular diseases;
– obstructive sleep apnea;
– obesity hypoventilation syndrome;
– joint disorders requiring surgery;
– non-alcoholic fatty liver disease;
– hyperlipidemia;
– female infertility including polycystic ovarian syndrome;
– relevant social and psychological indications;
– situations, when obesity is a reason for disqualification from a significant form of surgical treatment e.g. orthopedics surgery, hernia repair or neurosurgical procedures.
- Body mass index (BMI) 30–34.9 kg/m2 and type 2 diabetes mellitus in the event of hyperglycemia despite optimal pharmacological treatment.
Bariatric procedures are grouped in three main categories that include:
Restrictive procedures:
- Sleeve gastrectomy
- Adjustable gastric band
- Intragastric balloon
Malabsorptive procedures:
- Biliopancreatic diversion or Scopinaro procedure
Restrictive – malabsorptive procedures:
- Gastric bypass
- Minigastric bypass
- Single anastomosis duodenal – ileal bypass (SADI)
- Single anastomosis sleeve – ileal bypass (SASI)
Laparoscopic sleeve gastrectomy (LSG) is currently the most commonly performed bariatric procedures worldwide being the “gold standard” of bariatric/metabolic surgery. It is a type of restrictive procedure in which about 80% of the stomach volume is cut off along greater curvature. After the stomach resection, the leak test is performed. The stomach is removed through one of the trocars and it is sent for histopathological examination.
