Laparoscopic era of operations for morbid obesity

The goal of this article is to review the status of the emerging field of laparoscopic bariatric surgery, to discuss developmental issues regarding technique and training, and finally, to summarize the present and future roles of laparoscopic bariatric surgery. We reviewed all published literature from 1992 to the present on MEDLINE. Articles were excluded for analyses that were case reports or articles on technical aspects of given procedures. Laparoscopic vertical banded gastroplasty (LVBG) has reduced perioperative morbidity compared with the open approach but seems to have a low overall adoption rate, at least, in the United States. Laparoscopic adjustable silicone gastric banding (LASGB) has become firmly established in Europe and Australia. It has only recently been introduced in the United States. Laparoscopic adjustable silicone gastric banding has been proven to be an effective weight loss procedure in Europeans with morbid obesity. Laparoscopic Roux-en-Y gastric bypasses (LRYGBPs) can also be safely performed laparoscopically with weight loss similar to open Roux-en-Y gastric bypass surgery. Laparoscopic biliopancreatic diversion procedures (LBPDs) have been performed safely in a few small series, but overall, experience is insufficient to draw strong conclusions. All laparoscopic bariatric procedures have significant learning curves. Laparoscopic bariatric surgery can be safely performed for all types of bariatric operations. The laparoscopic approaches to bariatric surgery significantly reduce perioperative morbidity justifying the acquisition of skills needed to perform these procedures.