Background: Three premises underlie this formulation of an algorithm: 1) there is no gold standard operation; 2) the bariatric surgeon should be able to perform more than one bariatric operation; and 3) a patient can be broadly matched to an operation. Methods: Literature review and interpretation. Results: The 5 currently clinically-tested bariatric procedures, ranked from least to most weight loss, are: 1) gastric banding (GB); 2) vertical banded gastroplasty (VBG); 3) Roux-en-Y gastric bypass (RYGBP); 4) biliopancreatic diversion (BPD) or duodenal switch (DS); and 5) long-limb Roux-en-Y gastric bypass (LLRYGBP). The following diagram for decision-making takes into consideration body mass index (BMI); age; gender, race, and body habitus (GRH); and comorbidities (CoM): This diagram can be converted to an equation; OC=1.0+BMI Number (1 to 6) ±0.5 (agelang;40rang;) ±0.5 (GRH, Favorable or Unfavorable) ±1 (CoM, Low or High), where OC=operative category: GB=0 to 3, VBG=2 to 5, RYGBP=3 to 6, BPD/DS=4 to 7, and LLRYGBP=6 to 9. Overlap between OCs integers allows for surgeon and patient preference. Conclusions: A diagram or equation algorithm for operative selection in the morbidly obese has been constructed.
Bibliographical noteFunding Information:
Presented in part as a Special Lecture at the 7th Wordl Congress of the International Federation for the Surgery of Obesit,Sy oPaãl,ouBrazil, August 31, 2002. Reprint requests to: Henry Buchwald, MD,P D, hFACS, University of Minnesota, 420 Delaware Street SE, MayMoail Code 290, Minneapolis, MN 55455, USA. Fa: 61x2-625-3206; e-mail: firstname.lastname@example.org This work was sponsored in part by an unrestricted educational grant from Ethicon Endo-Surgery Inc., Cincinnati, OH, USA.
Copyright 2008 Elsevier B.V., All rights reserved.
- Bariatric surgery
- Biliopancreatic diversion/duodenal switch
- Gastric banding
- Morbid obesity
- Roux-en-Y gastric bypass
- Vertical banded gastroplasty