Alan A. Saber

Introduction

Obesity is a major health problem worldwide and has reached an epidemic proportion in Western society. A major risk factor for many diseases, obesity is associated with significant morbidity and mortality.

Bariatric surgery is currently the only modality that provides significant, long-term weight loss for the patient who is morbidly obese, with resultant improvement in obesity-related comorbidities. Gastric bypass is becoming the “gold standard” for surgical management of morbid obesity in the United States.

Surgical Criteria

Surgery for obesity should be considered a treatment of last resort after dieting, exercise, psychotherapy, and drug treatments have failed. National Institutes of Health (NIH) criteria for surgical treatment include a body mass index (BMI) of greater than 40 kg/m² or a BMI of greater than 35 kg/m² in combination with high-risk comorbid conditions.

Surgical Anatomy

Gastric bypass is the most common bariatric procedure. It has two components, restrictive and malabsorptive, which are both demonstrated in the depiction of a Roux-en-Y gastric bypass (Fig. 11-1, A). Because these patients are by definition morbidly obese, the excessive intraabdominal fat can make identification of the anatomy difficult. This chapter describes the anatomic landmarks during Roux-en-Y gastric bypass procedure.