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Bariatric Surgery and Long-term Control of Morbid Obesity

Robert E. Brolin, MD
JAMA. 2002;288(22):2793-2796. doi:10.1001/jama.288.22.2793.
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Obesity, defined as 20% or more than the ideal weight or body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) of 30 or more, has reached epidemic levels in the United States, affecting more than 30% of adults.1 Annual direct costs for treating obesity-related medical illnesses have been estimated at nearly $51.6 billion; the annual US expenditure on weight reduction exceeds $30 billion.2,3 It was recently estimated that the prevalence of obesity in US adults increased by 8% during the past decade. In the 21st century, obesity may be the number 1 US public health problem (http://www.surgeongeneral.gov/topics/obesity/).

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Figure. Bariatric Surgery Techniques
Graphic Jump Location
A, Vertical-banded gastroplasty. A 15 to 20 mL upper gastric pouch empties into the remainder of the stomach through a calibrated stoma. C, Roux-en-Y gastric bypass. A stapler fired across the cardia of the stomach creates a 20 to 30 mL pouch. The jejunum is divided distal to the ligament of Treitz with the distal end anastomosed to the upper stomach. D, Biliopancreatic diversion with duodenal switch. A sleeve resection of the greater curvature of the stomach is performed. The first portion of the duodenum is divided and the proximal duodenum and approximately half of the length of the small intestine (biliopancreatic limb) is excluded from digestive continuity. The small bowel is divided approximately 300 cm above the ileocecal junction, and the distal end is anastomosed to the first portion of the duodenum (alimentary limb). The distal end of the biliopancreatic limb is anastomosed to the ileum 50 to 100 cm proximal to the ileocecal junction.



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