Obesity may be difficult to overcome and in these situations the surgeons as always have explored surgical management of the problem.
In the Journal of the Royal College of Physicians of Edinburgh Witherspoon and Galloway review surgical procedures useful for obesity control.
Medical treatment for the grossly obese is not always effective in the long term.
In these situations bariatric surgery has much to offer.
The operations may be
1. restrictive procedures.
reducing the functional capacity of the stomach by reducing the capacity of the stomach with a band across the upper stomach
2 . operations resulting in malabsorption
These reduce the absorptive capacity of the intestine , either by bypassing part of the intestine or removing small bowel.
2. A mix of 1 and 2. Laparoscopic small gastric pouch with bypass of remaining stomach , duodenum and variable length of jejunum.
Weight loss may be very good, 50 to 75 %.
The gastric banding complications are mechanical, band erosion and slippage.
The creation of malabsorption requires very careful follow up as very severe complications may result. Apart from the malnutrition some patients will have disabling diarrhoea and incontinence.
Overall restrictive procedures are the best.
Witherspooon and Galloway 2008 Surgery for severe obesity: an effective cure for a difficult problem J R Coll Physicans Edin vol 38, 129-30

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