Surgery for obesity.

As were most types of gastrointestinal surgery, antiobesity surgery was dominated by the development of laparoscopic techniques during the last decade. The feasibility of performing any primary antiobesity operation safely laparoscopically was convincingly demonstrated during the last 2 years. This represents a significant continued improvement in the perioperative safety of "bariatric" surgery. However, antiobesity surgery entails very much more than technique. Unfortunately, little progress has been made in optimizing patient selection, improving follow-up, and devising strategies for reoperative antiobesity surgery. The latest publications in the field are mainly confirmatory, demonstrating durable medically significant weight loss resulting in comorbidity reduction with increased life expectancy. The most interesting contribution of this surgery is provision of "experimental models" using gastrointestinal physiology to study the pathophysiology of obesity and undernutrition by guaranteeing substantial weight loss maintained long-term. It is unfortunate that surgery for obesity is seriously underutilized.