Given the limited efficacy of anti-obesity medications and behavioral interventions, bariatric operations have provided an alternative yet durable approach to combat obesity and its comorbidities. Bariatric surgery has increased exponentially in the United States and has evolved to become one of the safer surgical operations performed in the United States, with a 30-day mortality rate of 0.3% and an early complication rate of 4.1%.15 Bariatric surgery encompasses several different procedures: Roux-en-Y gastric bypass, laparoscopic adjustable gastric band, and the biliopancreatic diversion and biliopancreatic diversion with duodenal switch (Figure). The 2 most commonly performed in the United States are the Roux-en-Y gastric bypass and laparoscopic adjustable gastric band. These procedures are recommended for patients with BMI ≥40 kg/m2 or ≥35 kg/m2 with at least 1 serious comorbidity. One type of laparoscopic adjustable gastric band was recently approved by the FDA (2011) for a lower BMI indication, BMI ≥35 kg/m2 or ≥30 kg/m2 with a serious comorbidity.
