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As overweight looms as a burgeoning public health menace, more morbidly obese patients are resorting to gastric bypass and restrictive surgery. About 120,000 weight-loss procedures were performed in 2003, triple the number reported in 2000.
In May, more than 200 surgeons and other obesity experts met at Georgetown University to assess the state of bariatric surgery, the first such meeting in 13 years. Sponsored by the American Society for Bariatric Surgery (ASBS), a panel of 12 experts considered 2 days of presentations on gastric surgery and its implications for patients, health professionals, and third-party payers.
The last time the field had been subject to such a review was 1991, when a National Institutes of Health (NIH) consensus panel developed a statement describing the best practices in bariatric surgery.
"When the panel addressed issues thirteen years ago, the world was a very different place," said conference moderator Walter J. Pories, MD, of East Carolina University. "Obesity was a problem; now it's an epidemic."
Since gastric bypass surgery for weight loss was introduced 30 years ago, more than 1,000 different techniques, approaches, and surgical variations have emerged—with widely varying potential complications and long-term effects. "There is no standardization of gastric bypass procedures," said Pories.
In 1991, the NIH consensus panel recommended two procedures for morbid obesity: vertical banded gastroplasty and short loop gastric bypass. Both are open procedures with significant risks, as well as unavoidable lifelong health consequences.
Since then, the field has been augmented by other interventions—such as laparoscopic gastric banding—that help patients lose weight while reducing the risk of complications and death. Bariatric operations commonly performed today include gastric bypass, duodenal switch, and pancreaticobiliary bypass. All of the procedures require careful dietary maintenance to avoid nutritional deficiencies.
One procedure gaining popularity is the laparoscopic adjustable gastric band, which is a procedure that involves encircling the upper stomach with a plastic band to create a small chamber that can only hold a bite or two of food. The band can be adjusted to alter the rate at which food passes through the digestive tract.
Laparoscopic surgery has a much lower complication rate and 10-fold lower risk of mortality than open gastric bypass procedures, according to Philip R. Schauer, MD, codirector of minimally invasive surgery at Magee-Womens Hospital in Pittsburgh. Patients who undergo laparoscopic surgery are discharged from the hospital earlier and return to work sooner than those who have open surgery.
Scientific consensus has not kept up with clinical practice, said Pories. Improved technique and the accumulation of clinical data over the last 13 years necessitate a review of bariatric surgery.
Following the model set by the NIH, the panel included representation from the American College of Surgeons, the American Obesity Association, and other professional groups. The scientific panel will work toward a consensus on issues including patient selection, surgical training, and access to care.
The ASBS consensus statement will be released in the fall and published in
a major medical journal, according to University of Minnesota surgeon Henry
Buchwald, MD, chairman of the scientific panel. 
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