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New Less-Invasive Surgery for Morbid Obesity

Patients that suffer from morbid obesity have only one way to sustained weight loss and reduction of comorbidities: surgery. Traditional—open—gastric bypass surgery often involves postoperative complications such as infections, pneumonia, and pulmonary embolism. However, a new minimally invasive technique known as laparoscopy can be used to treat morbid obesity, achieving similar long-term results as open surgery, but with fewer postoperative complications. The laparoscopic technique application to morbid obesity was developed over the last decade with the purpose of reducing postoperative pulmonary and wound complications. Today, over 75,000 procedures for weight loss are performed annually. This number increased considerably with the arrival of laparoscopy.

To be eligible for laparoscopic surgery the patient must be morbidly obese and have not had prior abdominal surgery. Patients with a high hip-to-waist ratio or a “pear” shape are well suited for a surgery of this sort. Candidates must undergo nutritional, endocrinologic and psychiatric evaluation. A nutritionist evaluates with the patient the alterations in the diet that will be needed after the surgery. An endocrinologist evaluates the overall medical management, including diabetic and antihypertensive medications and a psychiatrist looks for noncompliant behaviors that are contraindications for surgery such as drug or alcohol dependencies. Once these three professionals are consulted, the patient is referred to a general surgeon, who performs a preoperative evaluation, discusses the surgical technique with the patient in detail and reviews potential complications.

In a laparoscopic surgery, five small incisions are made, through which ports are inserted for abdominal access. The ligament of Treitz is recognized initially, and the proximal jejunum is divided around 35 cm distal to this point. Then, a procedure is performed with laparoscopic staplers. Finally, the ports are removed and the skin incisions are closed.

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