[New trends in bariatric surgery].

The surgical treatment of obesity reaches the 50th of last century. The first operations were based on significant shortening of digestive tract and were associated with many metabolic disturbances. The growing epidemic of obesity was the most decisive factor for the development of bariatric surgery. Because of its high efficacy (80%) comparing to the conservative treatment (5%), bariatric surgery today is the only effective therapy for morbid obesity. Surgical procedures can be categorized as restrictive, restrictive-malabsorptive, malabsorptive and others. The restrictive operations limit gastric volume. There are Vertical Banded Gastroplasty (VBG), Adjustable Gastric Banding (AGB) and Sleeve Resections (SR). The restrictive-malabsorptive are based on the creation of small gastric pouch or the resection of 4/5 of stomach and the shortening of common digestive tract. There are Gastric bypass (GB), and Biliopancreatic divertion with duodenal switch (BPD-DS). The malabsorptive procedure (Biliopancreatic divertion--BPD) are based on resection of 2/3 of stomach and significant shortening of digestive tract. The appearance of new bariatric operation such as SR changed the pattern of treating obesity with BMI >50 kg/m2. The two or three stage treatment of obesity minimizes the perioperative risk for patients. Although the great development of bariatric surgery there is no golden standard. The choice of procedure should be done by surgeon and patient together.