Endocrine Abstracts

European and world-wide obesity epidemic and continuously rising prevalence of obesity necessitates long-term efficient, economically bearable and patient safe solution. Bariatric surgery (surgery for obesity – different from lifestyle, body shaping surgery), is the most effective, low risk treatment modality for morbidly obese patients in terms of total weight loss and and long-term weight maintenance, currently available.

It has to be stressed however, that excellent bariatric results are fundamentally dependent on standardized patient selection (indication criteria) and close inter-disciplinary team collaboration. This applies not only on patient’s pre-operative assessment, however even more on the life-long post-operative period, during which the patient should be looked after by physicians, surgeons, and other specialists involved obesity management process (such as endocrinologists, diabetologists, dietologists…).

Nowadays, standard and widely accepted European indication criteria for bariatric surgery are available. Among other criteria, the patient should have Body Mass Index (BMI) >35 with serious co-morbidities, or BMI >40 even without them. BMI criterion may be current BMI or a documented previous BMI of this severity. However patients must have failed to loose weight or to maintain long-term weight loss, despite appropriate non surgical medical care. The basic surgical approaches to obesity are:

- Gastric restrictive/food limitation procedures (i.e. gastric banding), which mechanically limit (restrict) the amount of food patient able to eat at a time

- Operations limiting absorption of nutrients/”energy” (i.e. biliopancreatic diversion)

- Combined procedures (i.e. distal gastric bypass)/operations blending features of both of the previous

Author is going to discuss the indication, procedures and follow-up process in morbidly obese patients management algorithm.