New advances in laparoscopic treatment of morbid obesity.

The prevalence of obesity in the United States (U.S.) is increasing to epidemic proportions. Currently, more than 60% of Americans and 51% of Germans are overweight. Whereas a variety of medications are available for treatment of obesity, none results in the long-term loss of more than 10% of body weight. The current standard for treatment of severe obesity, defined as a body mass index (BMI) of greater than 35 kg/m2 with comorbidities and generally greater than 40 kg/m2, is surgical. Several surgical procedures are currently available, including gastric bypass, biliopancreatic diversion (BPD) with duodenal switch, and the adjustable gastric band. These operations may be performed using laparoscopic surgical techniques to minimize perioperative morbidity and postoperative recovery time. To optimize the outcome of this type of procedure, bariatric surgery should be performed on carefully selected patients, in bariatric centers specially equipped to care for the obese, within a broadly based, multidisciplinary setting that provides lifelong postoperative care.