Over the last decade, bariatric surgeons have witnessed more dramatic advances in the field of bariatric surgery than in the previous 50 years of this relatively young discipline. These changes have certainly been fueled by the great obesity epidemic beginning in the 1970's which created the demand for effective treatment of severe obesity and its co-morbidities. The gradual development and standardization of safer, more effective, and durable operations such as Roux-en Y gastric bypass (RYGB), biliopancreatic diversion, duodenal switch, and adjustable gastric banding account for the first wave of advances over the last decade. More recently, the advent of minimally invasive surgery in the mid 1990's accounts for the second wave of major advances.

Fifteen years ago, fewer than 15,000 bariatric procedures (mostly vertical banded gastroplasty) were performed each year in the U.S. and all were performed with a laparotomy requiring nearly a week of hospitalization and 6 weeks of convalescence. Mortality rates exceeding 2 percent and major morbidity exceeding 25% was the norm. It later became apparent that the laparotomy itself accounted for much of the morbidity of bariatric surgery contributing to major impairment in postoperative cardiopulmonary function leading to atelectasis, pneumonia, respiratory failure, heart failure, and lengthy stays in the intensive care unit for a significant subset of patients. Furthermore, wound complications including infections, seromas, hernias and dehisences were the norm rather than the exception. Hernias were so common (20-25%) that they were often considered the second stage of a bariatric procedure.

Today, over 200,000 bariatric procedures are performed each year in the U.S. and nearly twice that figure worldwide. Nearly all gastric banding procedures, an estimated 75% of RYGB procedures, and even some BPD procedures are performed laparoscopically indicating that the laparoscopic approach has been widely adopted in bariatric surgery. The dramatic reduction in postoperative pain, hospital stay to 1-3 days, recovery to 2-3 weeks, incidence of intensive care utilization to 50%). Laparoscopic cholecystectomy, Nissen fundoplication, and bariatric procedures represent the major triumphs thus far of the laparoscopic revolution. Perhaps, bariatric operations represent the best application of minimally invasive procedures because avoidance of an extensive laparotomy in the high-risk bariatric population provides the greatest relative benefit. We hope that you encounter as much enjoyment reading Minimally Invasive Bariatric Surgery as we have had writing it! Now, on to the next revolution in bariatric surgery!

Phil Schauer, MD

Bruce Schirmer, MD

Stacy Brethauer, MD

Résumé

"Minimally Invasive Bariatric Surgery" covers the full spectrum of laparoscopic weight loss surgery and the pathophysiology of obesity. The chapter authors, all currently operating experts in the field, cover the essentials of establishing a bariatric surgery program, including equipment needs, guidelines for training, and patient selection. The operative chapters discuss in full detail the surgical techniques and outcomes, including laparoscopic VGB, laparoscopic adjustable gastric banding, laparoscopic Roux-en-Y, and laparoscopic malabsorption procedures. The text also tackles post-operative issues, such as complications, reoperation, plastic surgery after weight loss, nutritional issues, and pregnancy following obesity surgery. The text is graphically enhanced with over 175 full-color and 265 black and white images: surgical photos, anatomical drawings, operative technique illustrations and management algorithms. "Minimally Invasive Bariatric Surgery" enables clinicians to provide their patients with a viable solution to chronic obesity.

Contenu

Pathophysiology of Obesity Comorbidity: The Effects of Chronically Increased Intraabdominal Pressure.- The Medical Management of Obesity.- Evolution of Bariatric Minimally Invasive Surgery.- Essential Characteristics of the Successful Bariatric Surgeon: Skills, Knowledge, Advocacy.- Bariatric Surgery Program Essentials.- Essential Bariatric Equipment: Making Your Facility More Accommodating to Bariatric Surgical Patients.- Bariatric Surgery Training.- Patient Selection, Preoperative Assessment, and Preparation.- The Evolving Role of the Psychologist.- Operating Room Positioning, Equipment, and Instrumentation for Laparoscopic Bariatric Surgery.- Access to the Peritoneal Cavity.- Comparison of Open Versus Laparoscopic Obesity Surgery.- Anesthesia for Bariatric Surgery: What a Surgeon Needs to Know.- Pneumoperitoneum in the Obese: Practical Concerns.- Postoperative Assessment, Documentation, and Follow-Up of Bariatric Roux-en-Y Surgical Patients.- Bariatric Data Management.- The Current Role of Open Bariatric Surgery.- Technical Pearls of Laparoscopic Bariatric Surgery.- Laparoscopic Vertical Banded Gastroplasty.- Laparoscopic Sleeve Gastrectomy.- Laparoscopic Adjustable Gastric Banding: Technique.- Laparoscopic Adjustable Gastric Banding: Outcomes.- Laparoscopic Adjustable Gastric Banding: Postoperative Management and Nutritional Evaluation.- Laparoscopic Adjustable Gastric Banding: Complications.- Laparoscopic Adjustable Gastric Banding: Revisional Surgery.- Laparoscopic Adjustable Gastric Banding: Controversies.- Circular Stapler Technique for Gastroenterostomy.- Circular Stapled Transabdominal Technique.- Laparoscopic Roux-en-Y Gastric Bypass: Hand-Sewn Gastrojejunostomy Technique.- Linear Stapled Technique for Gastrojejunal Anastomosis.- Laparoscopic Roux-en-Y Gastric Bypass: Outcomes.- Laparoscopic Roux-en-Y Gastric Bypass: Postoperative Management and Nutritional Evaluation.- Laparoscopic Roux-en-Y Gastric Bypass: Complications.- Gastric Bypass as a Revisional Procedure.- Laparoscopic Roux-en-Y Gastric Bypass: Controversies.- Laparoscopic Biliopancreatic Diversion with Duodenal Switch.- Laparoscopic Malabsorption Procedures: The Technique of Biliopancre atic Diversion.- Laparoscopic Malabsorption Procedures: Outcomes.- Laparoscopic Malabsorption Procedures: Postoperative Management and Nutritional Evaluation.- Laparoscopic Malabsorption Procedures: Complications.- Laparoscopic Malabsorption Procedures: Controversies.- Hand-Assisted Laparoscopic Bariatric Surgery.- Risk-Benefit Analysis of Laparoscopic Bariatric Procedures.- Alternative Minimally Invasive Options: Gastric Pacing.- The BioEnterics Intragastric Balloon for the Nonsurgical Treatment of Obesity and Morbid Obesity.- The Emerging Field of Endoluminal and Transgastric Bariatric Surgery.- Venous Thrombosis and Pulmonary Embolism.- Role of Flexible Endoscopy in the Practice of Bariatric Surgery.- Bariatric Surgery in Adolescents.- Bariatric Surgery in the Elderly.- The High-Rsisk Bariatric Patient.- Gastroesophageal Reflux Disease in the Bariatric Surgery Patient.- Gallbladder Disease in the Bariatric Surgery Patient.- Diabetes in the Bariatric Surgery Patient.- Cardiovascular Disease and Hypertension in the Bariatric Surgery Patient.- Sleep Apnea in the Bariatric Surgery Patient.- Ventral Hernias in the Bariatric Patient.- Plastic Surgery Following Weight Loss.- The Female Patient: Pregnancy and Gynecologic Issues in the Bariatric Surgery Patient.- Medicolegal Issues: The Pitfalls and Pratfalls of the Bariatric Surgery Practice.