Welcoming you for any type of article submission for the upcoming issue on/before February 26, 2021.

Review Article
Volume 5 Issue 2 - 2020
Surgery is a Viable Longterm Option for the Treatment of Severe Obesity
Rajat Gusani*, Mohit Bhandari, MAL Fobi, Manoj Reddy, Prashant Salvi and Manoj Khurana
Department of Bariatric and Metabolic Surgery, Mohak Bariatric and Robotic Surgical Center, Shri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India
*Corresponding Author: Rajat Gusani, Research Fellow, Department of Bariatric and Metabolic Surgery, Mohak Bariatric and Robotic Surgical Center, Shri Aurobindo Institute of Medical Sciences, Indore, Madhya Pradesh, India.
Received: October 31, 2019; Published: January 31, 2020


This Review focuses on obesity that is a world epidemic that is recalcitrant to non-surgical treatment and the only long-term option of management is surgical. Obesity is a chronic disease of excess fat storage due to a genetic predisposition and strong environmental contributions. Many treatment modalities have been proposed, however, bariatric metabolic surgery seems to be the only evidenced-based modality available that causes and maintains significant body weight loss over a long-term. Obesity has been implicated in multiple conditions such as cardiovascular diseases and diabetes amongst others. Though only 50 years old, bariatric metabolic surgery is under constant evolution. There are many procedures used for treatment of obesity. There is no one operation that is effective for all patients. We aim to illustrate surgery as a viable option in the treatment of the disease obesity.

Keywords: Obesity; Metabolic; Surgery; Bariatric; Hypertension; Diabetes; Jejuno Ileal Bypass; Banding; Gastric Bypass; One Anastomosis Gastric Bypass; Mini Gastric Bypass; Surgical Procedures; Surgical Disease


  1. “WHO Obesity”. WHO. Online (2019).
  2. MS Tremblay., et al. “Temporal trends in overweight and obesity in Canada, 1981-1996”. International Journal of Obesity 26.4 (2002): 538-543.
  3. T Kelly., et al. “Global burden of obesity in 2005 and projections to 2030”. International Journal of Obesity 32.9 (2005): 1431-1437.
  4. National Center for Health Statistics (US), Health, United States, 2017: With Special Feature on Mortality. Hyattsville (MD): National Center for Health Statistics (US) (2018).
  5. CL Ogden., et al. “Prevalence of childhood and adult obesity in the United States, 2011-2012”. Journal of the American Medical Association 311.8 (2014): 806-814.
  6. von Ruesten., et al. “Trend in obesity prevalence in European adult cohort populations during follow-up since 1996 and their predictions to 2015”. Plos One 6.11 (2011): e27455.
  7. M Ng., et al. “Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013”. Lancet 384.9945 (2014): 766-781.
  8. M Devaux and F Sassi. “Social inequalities in obesity and overweight in 11 OECD countries”. European Journal of Public Health 23.3 (2013): 464-469.
  9. B Sheikh., et al. “The Interplay of Genetics and Environmental Factors in the Development of Obesity”. Cureus 9.7 (2017): e1435.
  10. S O’Rahilly and IS Farooqi. “Human obesity as a heritable disorder of the central control of energy balance”. International Journal of Obesity 32.7 (2005): S55-61.
  11. J Walley., et al. “The genetic contribution to non-syndromic human obesity”. Nature Reviews Genetics 10.7 (2009): 431-442.
  12. JE Donnelly., et al. “American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults”. Medicine and Science in Sports and Exercise 41.2 (2009): 459-471.
  13. E Ponterio and L Gnessi. “Adenovirus 36 and Obesity: An Overview”. Viruses 7.7 (2015): 3719-3740.
  14. Parra-Rojas O., et al. “Adenovirus-36 seropositivity and its relation with obesity and metabolic profile in children”. International Journal of Endocrinology (2013): 463194.
  15. P Hossain., et al. “Obesity and diabetes in the developing world--a growing challenge”. The New England Journal of Medicine 356.3 (2007): 213-215.
  16. C Xiao., et al. “Oral taurine but not N-acetylcysteine ameliorates NEFA-induced impairment in insulin sensitivity and beta cell function in obese and overweight, non-diabetic men”. Diabetologia 51.1 (2008): 139-146.
  17. S Satapati., et al. “Elevated TCA cycle function in the pathology of diet-induced hepatic insulin resistance and fatty liver”. Journal of Lipid Research 53.6 (2012): 1080-1092.
  18. M Abdelaal CW le Roux and NG Docherty. “Morbidity and mortality associated with obesity”. Annals of Translational Medicine 5.7 (2017).
  19. A-C Huby., et al. “Adipocyte-Derived Hormone Leptin Is a Direct Regulator of Aldosterone Secretion, Which Promotes Endothelial Dysfunction and Cardiac Fibrosis”. Circulation 132.22 (2015): 2134-2145.
  20. J Cox NP West and AW Cripps. “Obesity, inflammation, and the gut microbiota”. The Lancet Diabetes and Endocrinology 3.3 (2015): 207-215.
  21. SR Spindler. “Rapid and reversible induction of the longevity, anticancer and genomic effects of caloric restriction”. Mechanisms of Ageing and Development 126.9 (2005): 960-966.
  22. EJ Fine., et al. “Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients”. Nutrition Burbank 28.10 (2012): 1028-1035.
  23. S Tsugane and M Inoue. “Insulin resistance and cancer: epidemiological evidence”. Cancer Science 101.5 (2010): 1073-1079.
  24. R Kaaks., et al. “Serum sex steroids in premenopausal women and breast cancer risk within the European Prospective Investigation into Cancer and Nutrition (EPIC)”. Journal of the National Cancer Institute 97.10 (2005): 755-765.
  25. NE Allen., et al. “Endogenous sex hormones and endometrial cancer risk in women in the European Prospective Investigation into Cancer and Nutrition (EPIC)”. Endocrine-Related Cancer 15.2 (2008): 485-497.
  26. V Lee., et al. “Enhancement of insulin-like growth factor signaling in human breast cancer: estrogen regulation of insulin receptor substrate-1 expression in vitro and in vivo”. Molecular endocrinology (Baltimore, Md.) 13.5 (1999): 787-796.
  27. Y Matsuzawa. “Therapy Insight: adipocytokines in metabolic syndrome and related cardiovascular disease”. Nature Clinical Practice Cardiovascular Medicine 3.1 (2006): 35-42.
  28. PE Peppard., et al. “Longitudinal study of moderate weight change and sleep-disordered breathing”. The Journal of the American Medical Association 284.23 (2000): 3015-3021.
  29. BG Phillips., et al. “Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea”. The American Journal of Physiology-Heart and Circulatory Physiology 279.1 (2000): H234-237.
  30. S Parekh and FA Anania. “Abnormal lipid and glucose metabolism in obesity: implications for nonalcoholic fatty liver disease”. Gastroenterology 132.6 (2007): 2191-2207.
  31. B Freeman., et al. “Analysis of gallbladder bile in morbid obesity”. The American Journal of Surgery 129.2 (1975): 163-166.
  32. P Portincasa., et al. “Effects of cholestyramine on gallbladder and gastric emptying in obese and lean subjects”. European Journal of Clinical Investigation 25.10 (1995): 746-753.
  33. P Portincasa and D Q-H Wang. “Intestinal absorption, hepatic synthesis, and biliary secretion of cholesterol: where are we for cholesterol gallstone formation?”. Hepatologists in Baltimore 55.5 (2012): 1313-1316.
  34. G Fantuzzi. “Adipose tissue, adipokines, and inflammation”. The Journal of Allergy and Clinical Immunology 115.5 (2005): 911-920.
  35. M Wolf., et al. “Adiponectin induces the anti-inflammatory cytokines IL-10 and IL-1RA in human leukocytes”. Biochemical and Biophysical Research Communications 323.2 (2004): 630-635.
  36. MOzata., et al. “Human leptin deficiency caused by a missense mutation: multiple endocrine defects, decreased sympathetic tone, and immune system dysfunction indicate new targets for leptin action, greater central than peripheral resistance to the effects of leptin, and spontaneous correction of leptin-mediated defects”. The Journal of Clinical Endocrinology and Metabolism 84.10 (1999): 3686-3695.
  37. Istvan K., et al. “Body weight and psychological distress in NHANES I”. International Journal of Obesity and Related Metabolic Disorders 16.12 (1992): 999-1003.
  38. EA Finkelstein., et al. “Obesity and severe obesity forecasts through 2030”. American Journal of Preventive Medicine 42.6 (2012): 563-570.
  39. PD Stein., et al. “Obesity and pulmonary embolism: the mounting evidence of risk and the mortality paradox”. Thrombosis Research 128.6 (2011): 518-523.
  40. J Kremen., et al. “An Experimental Evaluation of the Nutritional Importance of Proximal and Distal Small Intestine”. Annals of Surgery 140.3 (1954): 439-447. 
  41. EE Mason and C Ito. “Gastric bypass in obesity”. Surgical Clinics of North America 47.6 (1967): 1345-1351.
  42. AL Fobi H Lee and AW Fleming. “The surgical technique of the banded Roux-en-Y gastric bypass”. Journal of Obesity and Weight-loss Medication 8.2 (1989): 99-102.
  43. S Scholtz., et al. “Obese patients after gastric bypass surgery have lower brain-hedonic responses to food than after gastric banding”. Gut 63.6 (2014): 891-902.
  44. De Silva and SR Bloom. “Gut Hormones and Appetite Control: A Focus on PYY and GLP-1 as Therapeutic Targets in Obesity”. Gut Liver 6.1 (2012): 10-20.
  45. Tschöp C., et al. “Circulating ghrelin levels are decreased in human obesity”. Diabetes 50.4 (2001): 707-709, Apr.
  46. Geary. “Endocrine controls of eating: CCK, leptin, and ghrelin”. Physiology and Behavior 81.5 (2004): 719-733.
  47. DE Cummings., et al. “Plasma ghrelin levels after diet-induced weight loss or gastric bypass surgery”. The New England Journal of Medicine 346.21 (2002): 1623-1630.
  48. H Ma and ME Patti. “Bile acids, obesity, and the metabolic syndrome”. Best Practice and Research Clinical Gastroenterology 28.4 (2014): 573-583.
  49. P Liou., et al. “Conserved shifts in the gut microbiota due to gastric bypass reduce host weight and adiposity”. Science Translational Medicine 5.178 (2013): 178ra41.
  50. SL Faria., et al. “Diet-induced thermogenesis and respiratory quotient after Roux-en-Y gastric bypass surgery: a prospective study”. Surgery for Obesity and Related Diseases 10.1 (2014): 138-143.
  51. LT DeWind and JH Payne. “Intestinal bypass surgery for morbid obesity: long-term results”. Journal of the American Medicine Association 312.9 (2014): 966-966.
  52. Scopinaro E., et al. “Bilio-pancreatic bypass for obesity: II. Initial experience in man”. British Journal of Surgery 66.9 (1979): 618-620.
  53. N Scopinaro., et al. “Biliopancreatic diversion”. World Journal of Surgery 22.9 (1998): 936-946.
  54. Marceau., et al. “Biliopancreatic diversion with duodenal switch”. World Journal of Surgery 22.9 (1998): 947-954.
  55. B Anderson., et al. “Biliopancreatic diversion: the effectiveness of duodenal switch and its limitations”. Gastroenterology Research and Practice 2013 (2013): 974762.
  56. JP. Gebelli., et al. “Sadi-S With Right Gastric Artery Ligation: Technical Systematization And Early Results”. Brazilian Archives of Digestive Surgery 1.1 (2016): 85-90.
  57. H Zaveri., et al. “Mid-term 4-Year Outcomes with Single Anastomosis Duodenal-Ileal Bypass with Sleeve Gastrectomy Surgery at a Single US Center”. Obesity Surgery 28.10 (2018): 3062-3072.
  58. EE. Mason. “Vertical banded gastroplasty for obesity”. Archives of Surgery 1960 117.5 (1982): 701-706.
  59. HL Laws. “Standardized gastroplasty orifice”. The American Journal of Surgery 141.3 (1981): 393-394.
  60. K Kolle O Bo and J Stadaas. “Gastric banding”. In OMGI 7th Congress, Stockholm 145 (1982): 37.
  61. JM Fink., et al. “Banding the Sleeve Improves Weight Loss in Midterm Follow-up”. Obesity Surgery 27.4 (2017): 1098-1103.
  62. SB Bashour and R W Hill. “The gastro-clip gastroplasty: an alternative surgical procedure for the treatment of morbid obesity”. Tex Med 81.10 (1985): 36-38.
  63. MA Fobi and H. Lee. “The surgical technique of the Fobi-Pouch operation for obesity (the transected silastic vertical gastric bypass)”. Obesity Surgery 8.3 (1998): 283-288.
  64. HJ Sugerman., et al. “Conversion of proximal to distal gastric bypass for failed gastric bypass for superobesity”. Journal of Gastrointestinal Surgery 1.6 (1997): 517-524.
  65. Rutledge. “The mini-gastric bypass: experience with the first 1,274 cases”. Obesity Surgery 11.3 (2001): 276-280.
  66. W-J Lee., et al. “Laparoscopic Roux-en-Y vs. mini-gastric bypass for the treatment of morbid obesity: a 10-year experience”. Obesity Surgery 22.12 (2012): 1827-1834.
  67. G Lopez-Nava., et al. “Endoscopic sleeve gastroplasty with 1-year follow-up: factors predictive of success”. Endoscopy International 4.2 (2016): E222-227.
  68. Gaur S., et al. “Balancing risk and reward: a critical review of the intragastric balloon for weight loss”. Gastrointestinal Endoscopy 81.6 (2015): 1330-1336.
  69. L Milone., et al. “Effect of a polyethylene endoluminal duodeno-jejunal tube (EDJT) on weight gain: a feasibility study in a porcine model”. Obesity Surgery 16.5 (2006): 620-626.
  70. H Sam., et al. “The role of the gut/brain axis in modulating food intake”. Neuropharmacology 63.1 (2012): 46-56.
  71. H Rajagopalan., et al. “Endoscopic Duodenal Mucosal Resurfacing for the Treatment of Type 2 Diabetes: 6-Month Interim Analysis from the First-in-Human Proof-of-Concept Study”. Diabetes Care 39.12 (2016): 2254-2261.
Citation: Rajat Gusan., et al. “Surgery is a Viable Longterm Option for the Treatment of Severe Obesity”. EC Endocrinology and Metabolic Research 5.2 (2020): 01-30.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

March Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the March issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before April 03, 2023.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.