Considerations
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and the International Laparoscopic
Obesity Surgery Team (ILOST)
In the past 30 years, there has been a rapid evolution in the field of surgical treatments for obesity. Since the 1960s, when the surgical procedures essentially determined malabsorption (intestinal by-pass), there has lately been an evolution to procedures of "behavioral surgery." The most advanced is the laparotomic adjustable gastric banding procedure, and even more so, the laparoscopic surgery.
This was made possible thanks to advances in technology, which have placed complex prostheses and surgical instruments at the surgeons' disposal. The LAP-BAND® Adjustable Gastric Banding System constitutes a great step forward in the treatment of morbid obesity, as it preserves the anatomical and functional integrity. It also is totally reversible and adjustable in the course of time according to the patient's needs.
Therefore, in the field of general surgery, a specific specialization has gradually become prominent. Known as bariatric surgery or surgical treatment of obesity, it is coordinated by scientific organizations constituted and supported by scientific publications. Published research allows dissemination of the most recent findings and adequate update for professionals in this discipline.
The level of specialization achieved by the American Society of Bariatric Surgery, an undisputed international reference point in this field, is such that they stress that this type of surgery be performed only by surgeons who have specific training. These surgeons also must be aware of the metabolic and behavioral alterations this surgery may cause and be trained to cope with the situation.
Furthermore, the American Society of Bariatric Surgery recommends that laparoscopic surgery be performed only by surgeons experienced in both open surgical techniques and in advanced laparoscopic methods. Surgeons having neither training nor experience cannot summarily improvise such surgery; otherwise it may yield unacceptable mortality and high levels of complications.
It also is of fundamental importance that the surgery be personalized. This implies a wide range of technical knowledge by the surgeon who must be able to perform diverse surgical techniques based on the patient's physical and psychological condition.
Treatment of obesity is not confined solely to surgery, albeit highly sophisticated. In order to be efficacious with reduced risk factors, treatment of obesity requires the sum of specific multidisciplinary training by dieticians, internal medicine physicians, surgeons and psychologists.
As for the operation, particularly because of the most recent evolution of gastric banding, it is an eminently "functional" surgery. The slightest details of surgical technique must be strictly observed. Its importance lies in the framework of anatomic organs that may be easily lesioned, such as the spleen, stomach and mediastinum. Incorrect positioning of the gastric banding, even by a few millimeters, or an incorrect calibration of the neostoma, may invalidate the surgical procedure and lead to complex and unacceptable morbidity.
Having direct experience in both standard obesity surgery and the LAP-BAND® Adjustable Gastric Banding System, Dr. Guy-Bernard Cadiere and I, along with the other ILOST surgeons, are among the few specialists worldwide capable of offering patients this level of expertise. In fact, Dr. Cadiere and I were the first to develop and standardize the laparoscopic application of the LAP-BAND procedure internationally as early as 1993, and have performed the procedure on more than 1,500 patients with the lowest reported rate of complications.
On behalf of the ILOST surgeons, I wish you good luck in your endeavor to lose weight. Please feel free to contact our team if you have any inquiries.