The authors present their experience at the Centre for the surgical treatment of
morbid obesity at Milano University where since 1974, 603 obese patients underwent surgery: 312
jejuno-ileal bypass (JIB), 70 bilio-
intestinal bypass (BIB), 102 horizontal
gastroplasties (HGP), 44
silastic ring vertical
gastroplasties (SRVGP) and 75 adjustable
silastic gastric banding (ASGB). Average follow-up for these procedures is 16, 6, 11, 4 years and 24 months respectively.
Weight loss is satisfactory in all cases even though the percentages vary in the different procedures. The most serious complications (severe
hepatic failure, oxalic
interstitial nephritis, persisting malabsorption) occurred in patients submitted to JIB. The best clinical outcome with the lowest complications rate was obtained with BIB compared to other
intestinal bypasses. The most frequent complication observed in patients submitted to
gastroplasties was incoercible
vomiting while the most severe complications were diffuse
peritonitis, secondary to gastric perforation, and peripheric neuropathy. Our experience confirms that surgical treatment of
morbid obesity refractory to medical
therapy is today a safe and effective treatment. BIB has still a role in super-obese young patients (BMI over 50) refusing
dietary restriction lifetime. The gastric procedures, especially laparoscopic ASGB, seem to be the best option. The excellent outcome of
bariatric surgery can be obtained only in specialized centers where various specialists work together.