Surgery for morbid obesity. Appraisal of old and new techniques.

Morbid obesity is a serious and sometimes lethal disease of unknown etiology. Nonsurgical treatment has not been successful in producing permanent weight loss. Surgical treatment does reliably result in weight loss but is not a cure and is not indicated for all morbidly obese patients. Jejunoileal bypass, the first operation devised for morbid obesity, usually produces excellent weight loss but has high rates of morbidity and mortality. For this reason, it is not currently advised by most surgeons. Gastric bypass reduces morbidity and mortality without compromising weight loss; however, it is technically more difficult than jejunoileal bypass. The newest operations for morbid obesity are variations of gastroplasty. If correctly performed, they will produce satisfactory weight loss with the lowest morbidity rates of all the operations for morbid obesity. However, long-term results for these procedures are not yet available. Therefore, the ideal operative procedure for morbid obesity has yet to be identified.