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 DEFINITION
The surgery of the obesity should appear only in chosen cases of morbid obesity (serious pathological obesity).
RISKS
The operative risk of all the interventions is similar. The mortality is not raised, and the most frequent cause of death is not related to the skill but to the pulmonary muddle, other medical complications (lung, heart, etc.) and the grade of obesity.
EFFICACY
The morbid obesity is very difficult to recover and the time has demonstrated that with medicines and even with the surgery it is an illness very "resistant" to all the treatments. Generally the simple interventions have a high index of long-term defeat. The current interventions can make to lose 50 % of the excess weight, and help very much to the rest, and his effects often last of for life.
Many operations, nevertheless, do not obtain it, and also they affect to the quality of life of the produced one. In some operations it is frequent to have to re-operate for trumping the skill in the loss of weight.
SKILLS
- The Ringed Vertical Gastroplasty (GVA). In the long term he supposes a reoperations index between 25 and 50 per cent. Half of the defeats they stem from the operation and another half to the proper patients, who support meals ingestion with high caloric index that make them gain weight. The quality of life is not good because, of for life, the patient is condemned to "not to enjoy" of the meal.
- The adaptable ring for laparoscopy. It is possible to apply for laparoscopy (direct vision of the abdomen for optical fibre pipe across a tiny incision), that is to say, without opening the abdomen, but it was not possible to have demonstrated that the long-term results are better than the G.V.A.
- The gastric Bypass: It is the operation that more is realized between the surgeons expert in obesity. The reoperations index is very low. The losses of weight, top in all the statistics to the GVA and the adaptable ring. The "index of priest" is superior to 80 % and the rest of the patients, if they do not recover, they improve. It has side effects that it is necessary to watch but that are minimal and controlables.
- The "Crossing duodenal" or pancreatic Bypass: It is the most effective operation. He "treats" more than 90-95 % of the patients, and the rest they improve. It gives the best quality of life since they can consume all kinds of meals without restrictions in most cases. The reoperations index does not overcome 2 %. It is most indicated in the most obese patients, since they need to lose more weight of permanent form. Up to 3 years they can lose so much weight that the possible complications of the iron, calcium or vitamins must be corrected.
Indications. Not all the obese ones are equal and, therefore, it is not necessary to do the same intervention to them either. The most obese patients (the superobese ones) need the most aggressive operation that makes possible, of the most effective form, his return to the normality. In slightly less obese, the gastric bypass is the most used intervention, generally for laparoscopy.
RESULTS
The loss of weight is not immediate but slow and progressive.
It is going to depend on the grade of severity of the obesity. The more obese the more weight gets lost and also the more weight has to lose. It can be 5-8 Kilos per month at first to be diminishing when they happen the months and the weight, to lose already, is minor.
It is very difficult to go down up to the ideal weight. The best result with all kinds of operations is when the patient stays weighing at least 10 % over the ideal weight. No surgeon can predict the final weight with any of the operations. The individual changes are so big that there is no uniformity not with the same type of operation.
WHAT DOCTOR CAN TREAT ME?
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DEFINITION 
