Health-related quality of life before and after bariatric surgery in adolescents

Background

Recent data reaffirm decreased health-related quality of life (HRQL) in obese adults and children. Health-related quality of life is markedly improved after bariatric surgery in adults. Little HRQL data are available in adolescents undergoing bariatric surgery.

Methods

Sixteen patients (14-20 years old) underwent gastric bypass. Thirteen patients completed a general HRQL measure (Short Form 36 [SF-36]) before surgery. Of these, 9 completed the SF-36 again at various follow-up times, as well as a measure of weight-related quality of life (Impact of Weight on Quality of Life-Lite). Three patients completed postsurgical forms only. Data were analyzed using t test and analysis of variance. Results are reported as mean ± SD.

Results

Mean age and body mass index at operation were 18.5 ± 1.7 years and 54 ± 7.6 kg/m². Postoperatively, patients lost an average of 66% ± 29% excess weight over a mean follow-up of 17 ± 12 (range, 1-39) months. Mean preoperative SF-36 physical component score was 34.7 ± 10 and mental component score was 40.6 ± 13.5 (adult population mean = 50.0 ± 10 for each). At last follow-up, mean physical component score had increased to 55.5 ± 5, and mental component score, to 55.2 ± 8.6 (P < .0001). Adolescent Impact of Weight on Quality of Life-Lite scores after surgery did not differ from means for normal weight adults (93% ± 7% vs 96% ± 7%, P = .15).

Conclusions

Health-related quality of life in adolescents and young adults undergoing bariatric surgery improves dramatically in early follow-up. Long-term data are needed to definitively study this surgical therapy for obesity in adolescents.     

Cognitive function is linked to adherence to bariatric postoperative guidelines

BackgroundImpairment in cognitive function is found in a significant subset of individuals undergoing bariatric surgery, and recent work shows this impairment is associated with smaller postoperative weight loss. Reduced cognitive function could contribute to poorer adherence to postoperative guidelines, although this has not been previously examined. The present study examined the relationship between cognitive function and adherence to bariatric postoperative guidelines. We expected that higher cognitive function would be associated with better adherence to postoperative guidelines.MethodsThirty-seven bariatric surgery patients completed cognitive testing and a self-report measure of adherence to postoperative bariatric guidelines during their 4- to 6-week postoperative appointment.ResultsStrong correlations were observed between adherence to postoperative guidelines and cognitive indices of attention, executive function, and memory.ConclusionsResults show that cognitive performance is strongly associated with adherence to postoperative guidelines shortly after bariatric surgery. Further work is needed to clarify whether this relationship is present at later postoperative stages and the degree to which this relationship mediates postoperative weight loss outcomes.     

Long-term follow-up of disease-specific quality of life after bariatric surgery

Background

Substantial improvements in health-related quality of life measured by generic questionnaires (most often the Short Form-36) have been noted over the long term in patients with morbid obesity who had undergone bariatric surgery.

Predictors of improved psychological function after bariatric surgery

BackgroundNegative psychological sequelae have been reported after bariatric surgery. It is unclear which factors affect psychological function in the first postoperative years.ObjectiveEvaluation of significant predictors of improved psychological function following bariatric surgery by analyzing data from the BODY-Q questionnaire.SettingMulticenter prospective cohort in 3 centers located in The Netherlands and Denmark.MethodsThe BODY-Q questionnaire was used to assess 6 domains of health-related quality of life. The domain of interest, psychological function, consists of 10 questions from which a converted score of 0 (low) to 100 (high) can be calculated. Linear mixed models were used to analyze which patient characteristics were most predictive of the psychological function score. Secondary outcomes of interest were cross-sectional scores of psychological function and the impact of weight loss, and the effect of major short-term complications on psychological function.ResultsData were analyzed from 836 patients who underwent bariatric surgery from 2015 to 2020. Patients with lower expectations concerning weight loss (<40% desired total weight loss), higher educational level, no history of psychiatric illness, and employment before bariatric surgery demonstrated the highest psychological function scores after bariatric surgery. At 1 and 2 years after bariatric surgery, more weight loss was associated with significantly higher psychological function scores. Experiencing a major short-term complication did not significantly impact psychological function.ConclusionsSeveral relevant predictors of improved postoperative psychological function have been identified. This knowledge can be used to enhance patient education preoperatively and identify patients at risk for poor psychological functioning postoperatively.     

Weight loss and quality of life after bariatric surgery: a 2-year longitudinal study

BackgroundBariatric surgery is currently recognized as being an effective technique for weight loss and the improvement of patients’ postoperative well-being.ObjectivesThe objective of the study was to measure changes in quality of life (QoL) and body mass index (BMI) according to patients’ sex and 2 types of surgical procedures.SettingLongitudinal cohort study using an online platform from a private hospital in West France.MethodsTwo hundred six patients (38 men and 168 women) undergoing one-anastomosis gastric bypass or sleeve gastrectomy surgery provided online information concerning their QoL and weight both before the operation and then every 3 months over a postoperative period of 24 months.ResultsBMI clinically decreased on average by 19.6% in the first 3 months and up to 39.2% 24 months after surgery. Slight differences between men and women appeared as from 18 months after the operation, with men experiencing increased BMI between 18 and 24 months, contrary to women whose BMI remained unchanged during the same period. QoL also improved significantly. The average level of women’s quality of life increased between 3 and 15 months after surgery, then decreased between 15 and 24 months. As for men, no change was observed in their improved QoL between 3 and 24 months after the operation.ConclusionsThis study highlights the importance of optimizing patients’ monitoring, notably around 15 to 18 months after bariatric surgery. This period can be identified as a first “critical” period during which weight regain (especially for men) and diminished self-perceived quality of life (especially for women) appear.     

Cognitive function predicts 24-month weight loss success after bariatric surgery

BackgroundClinically significant cognitive impairment, particularly in attention/executive and memory function, is found in many patients undergoing bariatric surgery. These difficulties have previously been linked to decreased weight loss 12 months after surgery, but more protracted examination of this relationship has not yet been conducted. The present study prospectively examined the independent contribution of cognitive function to weight loss 24 months after bariatric surgery. Given the rapid rate of cognitive improvement observed after surgery, postoperative cognitive function (i.e., cognition 12 weeks after surgery, controlling for baseline cognition) was expected to predict lower body mass index (BMI) and higher percent total weight loss (%WL) at 24-month follow-up.MethodsData were collected by 3 sites of the Longitudinal Assessment of Bariatric Surgery (LABS) parent project. Fifty-seven individuals enrolled in the LABS project who were undergoing bariatric surgery completed cognitive evaluation at baseline, 12 weeks, and 24 months. BMI and %WL were calculated for 24-month postoperative follow-up.ResultsBetter cognitive function 12 weeks after surgery predicted higher %WL and lower BMI at 24 months, and specific domains of attention/executive and memory function were robustly related to decreased BMI and greater %WL at 24 months.ConclusionsResults show that cognitive performance shortly after bariatric surgery predicts greater long-term %WL and lower BMI 24 months after bariatric surgery. Further work is needed to clarify the degree to which this relationship is mediated by adherence to postoperative guidelines.     

A behavioral rating system predicts weight loss and quality of life after bariatric surgery

Background

Bariatric surgery represents the most effective intervention for severe obesity available today; however, significant variability in postoperative outcomes exists. Effective tools that predict postoperative outcomes are needed for decision-making and patient counseling.

Predictors of bariatric surgery among an interested population

BackgroundSeverely obese patients considering bariatric surgery face a difficult decision given the tradeoff between the benefits and risks of surgery. The objectives of this study was to study the forces driving this decision and improve our understanding of the decision-making process.MethodsA 64-item survey was developed to assess factors in the decision-making process for bariatric surgery. The survey included the decisional conflict scale, decision self-efficacy scale, EuroQol 5D, and the standard gamble. Patients were recruited from a regularly scheduled bariatric surgery interest group meeting associated with a large, university-based bariatric practice and administered a survey at the conclusion of the interest group. Logistic regression models were used to predict who pursued or still planned to pursue surgery at 12 months.Results200 patients were recruited over an 8-month period. Mean age was 45 years; mean BMI was 48 kg/m², and 77% were female. The 12-month follow-up rate was 95%. At 12 months, 33 patients (17.6%) had surgery and 30 (16.0%) still planned to have surgery. There was no association between age, gender, or obesity-associated conditions and surgery or plan to have surgery. Patients having surgery or still planning to have surgery had significantly worse scores for quality of life and better scores for decisional conflict (indicating readiness to make a decision).ConclusionThe decision to have bariatric surgery is strongly associated with patientsʼ perceptions of their current quality of life. In addition, lower decisional conflict and higher self-efficacy are predictive of surgery. Interestingly, factors that clinicians might consider important, such as gender, age, and the presence of obesity-associated co-morbidities did not influence patientsʼ decisions.     

Unrealistic weight loss expectations in candidates for bariatric surgery

BACKGROUND: Unrealistic expectations of weight loss are prevalent in obese patients and can negatively affect their adherence to dietary and health goals. We sought to examine the expectations and perceived notions about weight loss in candidates for bariatric surgery. METHODS: A total of 284 consecutive and prospective bariatric patients were surveyed using a validated Goals and Relative Weights questionnaire before an educational seminar. The participants categorized their weight loss expectations as "dream," "happy," "acceptable," and "disappointed" and rated the effect of surgically-induced weight loss on 21 indicators of health, quality of life, social functioning, and self-image on a 1-10 scale. The data are presented as the mean +/- standard deviation. RESULTS: Of the 284 patients, 230 were women and 54 were men (age 45 +/- 10 years; body mass index 50 +/- 8 kg/m(2)). These patients stated that their "dream" weight would be 89% +/- 8% excess body weight loss and that 77% +/- 9%, 67% +/- 10%, 49% +/- 14% excess body weight loss would be their "happy," "acceptable," and "disappointed" weight, respectively. Participants ranked health, fitness, body image, work performance, and self-confidence as the most important benefits of bariatric surgery. Women had greater "happy" and "acceptable" weight loss expectations and put more emphasis on physical presence (r = .17-.33, P <.01). Younger patients put more emphasis on attractiveness and improvements in social and sex life after bariatric surgery (r = .15-.19, P <.01). CONCLUSION: The results of our study have shown that although the candidates for bariatric surgery understand its benefits, they have unrealistic expectations of weight loss. In our study, the patients' most modest weight loss expectation, the "disappointed" weight, was equivalent to what providers would consider a successful weight loss outcome after bariatric surgery. Setting realistic expectations is an important aspect of the preoperative evaluation and education, especially for younger women.     

Quality indicators in bariatric surgery: improving quality of care

OBJECTIVES: Bariatric surgery is one of the most common complex intraabdominal operations, and there are reports of variations in outcome among providers. There is a need to standardize the processes of care in this specialty, and, as an attempt to do so, quality indicators were developed. METHODS: Candidate indicators, covering preoperative to follow-up care (5 domains), were developed based on evidence in the literature. Indicators were formally rated as valid by use of the RAND/UCLA Validity and Appropriateness method, which quantitatively assesses the expert judgment of a group using a 9-point scale (1 = not valid; 9 = definitely valid). Fourteen individuals participated in the expert panel, including bariatric surgeons and obesity experts. The method is iterative with 2 rounds of ratings and a group discussion. Indicators with a median rating > or =7 were valid. This method has been shown to have content, construct, and predictive validity. RESULTS: Of 63 candidate indicators, 51 were rated as valid measures of good quality of care covering the spectrum of perioperative care for bariatric surgery. Of the 51 indicators rated as valid (> or =7), all had sufficient "agreement" scores among panelists. Indicators included structural measures (e.g., procedural volume requirements) as well as processes of care (e.g., receipt of preoperative antibiotics, use of clinical pathway). CONCLUSIONS: This is the first formal attempt at development of quality indicators for bariatric surgery. Adherence to the indicators should equate with better quality of care, and their implementation will allow for quantitative assessment of quality of care.     

Cognitive function after bariatric surgery: evidence for improvement 3 years after surgery

Background

Bariatric surgery is associated with improved cognition, and it is possible that such improvements are found at extended follow-ups. We hypothesized that cognitive improvement would be maintained 3 years after bariatric surgery.

Methods

Fifty bariatric patients were recruited from the Longitudinal Assessment of Bariatric Surgery parent project. Participants completed a computerized cognitive test battery to assess cognitive function at 12 weeks, 12 months, 24 months, and 36 months after surgery.

Results

Repeated measures revealed main effects for attention, executive function, and memory. Attention improved up to 24 months and then slightly declined although it still fell within the average range at 36 months. Improvements in executive function reached their peak at 36 months after surgery. Short-term improvements in memory were maintained at 36 months. No main effect emerged for language.

Conclusions

Bariatric surgery may lead to lasting improvements in cognition. Prospective studies with extended follow-ups (eg, 10 years) should examine whether bariatric surgery can attenuate cognitive decline in severely obese patients.     

Six-minute walk test: functional capacity of severely obese before and after bariatric surgery

BackgroundThe 6-minute walk test (6MWT) is a well-known instrument for assessing the functional capacity of a variety of groups, including the obese. It is a simple, low-cost and easily applied method to objectively assess the level of exercise capacity. The aim of the present study was to study the functional capacity of a severely obese population before and after bariatric surgery.MethodsA total of 51 patients were studied. Of the 51 patients, 86.2% were women, and the mean age was 40.9 ± 9.2 years. All 51 patients were evaluated preoperatively and 49 were evaluated 7–12 months postoperatively. The initial body mass index was 51.1 ± 9.2 kg/m², and the final body mass index was 28.2 ± 8.1 kg/m². All patients underwent Roux-en-Y gastric bypass. The 6MWT was performed in a hospital corridor, with patients attempting to cover as much distance as they could, walking back and forth for as long as possible within 6 minutes at their regular pace. The total distance, Borg Scale of perceived exhaustion, modified Borg dyspnea scale for shortness of breath, and physical complaints at the end of the test were recorded. In addition, the heart rate and respiratory frequency were assessed before and after the test.ResultsThe tolerance was good, and no injuries occurred at either evaluation. The patients' mean distance for the 6MWT was 381.9 ± 49.3 m before surgery and 467.8 ± 40.3 m after surgery (p <.0001). Similar results were observed for the other parameters assessed.ConclusionThe 6MWT provided useful information about the functional status of the obese patients undergoing bariatric surgery. A simple, safe, and powerful method to assess functional capacity of severely obese patients, the 6MWT is an objective test that might replace the conventional treadmill test for these types of patients.     

School and cognitive functioning problems in adolescent bariatric surgery candidates

BackgroundPrior studies have reported that students with overweight and obesity have impairments in performance IQ and executive function and worse school functioning in comparison with peers of normal weight. The present study assessed school and cognitive functioning in a sample of adolescents with severe obesity being evaluated for laparoscopic adjustable gastric banding.MethodsEligible candidates for bariatric surgery were referred for psychiatric evaluation, which included a semistructured clinical interview measuring school functioning and the vocabulary and matrix reasoning subtests of the Wechsler Abbreviated Scale of Intelligence (WASI).ResultsSelf-reported school problems were common, with 55.5% of adolescents failing a grade or subject, 38.7% attending summer school, and 17.8% failing a citywide examination. A significant relationship was observed between body mass index, estimated WASI IQ (r = ?.250; P = .005), and the vocabulary subtest (r = ?.241; P = .006), but not matrix reasoning (r = ?.126; P = NS).ConclusionEven among a sample of adolescents with severe obesity, increased body mass index was associated with lower WASI IQ and vocabulary subtest scores. Increasing awareness of potential cognitive and school problems in bariatric candidates among teachers, school counselors, and other mental health providers is an important first step to improving academic support and educational systems deficiencies for students with overweight and obesity.     

Impact of bariatric surgery on the risk of hospitalization due to influenza virus infection

BackgroundObesity independently increases the risk of hospitalization due to viral respiratory infections, including influenza virus and, more recently, severe acute respiratory syndrome coronavirus 2. As an independent risk factor, obesity impairs the immune response to viral infections and decreases the effectiveness of immunizations.ObjectivesUsing influenza as a proxy, we aimed to determine the impact of bariatric surgery (BaS) on the risk of hospitalization due to viral respiratory infections.SettingAcademic hospital, United States.MethodsNational (Nationwide) Inpatient Sample data collected from 2010 to 2015 were examined. Patients were classified as treatment and control groups. Treatment subjects were defined as patients with a history of BaS and control subjects as patients with a body mass index ≥35 kg/m² and without a history of BaS. Any hospitalization with influenza as a primary diagnosis was identified. Univariate analysis and multivariate regression models were performed to assess the differences between groups.ResultsA total of 2,300,845 subjects were reviewed, of which 2,004,804 were control subjects and 296,041 were treated patients. Univariate analysis showed that the hospitalization rate in the treatment group was significantly lower than in the control group (.007% versus .019%, P < .0001), which was confirmed after adjusting for covariables (control versus treatment: odds ratio = 2.21, P = .0010).ConclusionsBaS may decrease the risk of hospitalization due to influenza, but further prospective studies are needed to confirm these results. We also suggest that these results should be translated into the development of similar studies to determine the impact of BaS on the incidence and severity of the coronavirus disease 2019.     

Evidence of executive dysfunction in extremely obese adolescents: a pilot study

BackgroundObesity in children and adolescents is 1 of the most urgent and serious health threats confronting the United States. Extremely obese adolescents (body mass index >99th percentile for age and gender) are a unique subgroup of obese youth who are at considerable medical and psychosocial risk. Little is known about the cognitive function of extremely obese adolescents. The present study sought to examine the cognitive performance of a sample of extremely obese adolescents seeking primary treatment for weight loss.MethodsAdolescents were recruited during regularly scheduled medical appointments at a children's center for weight management associated with a major children's hospital in the Southeast United States. A computerized battery of cognitive tests was administered to obese adolescents (body mass index >99th percentile; n = 25).ResultsObese adolescents exhibited deficits in many cognitive domains, including impairment in attention and executive functions (e.g., mental flexibility, disinhibition) compared with the normative data.ConclusionAlthough preliminary, these data have provided evidence for specific cognitive deficits in extremely obese adolescents. These findings highlight a need to determine whether early weight loss interventions, such as bariatric surgery, for obese adolescents could potentially prevent or reverse cognitive deficits and/or reduce the risk of future adverse neurocognitive outcome.     

Weight loss, quality of life and employment status after Roux-en-Y gastric bypass: 5-year analysis

BACKGROUND: Obesity can have a tremendous impact on the psychosocial, physical, and economic health of those afflicted by it. We hypothesized that if surgery results in significant weight loss and improves quality of life, those unemployed and disabled as a result of their morbid obesity might be more likely to become gainfully employed after Roux-en-Y gastric bypass (RYGBP). METHODS: We reviewed the medical charts of all patients who underwent RYGBP from April 1998 to December 1999. Demographics and employment status were obtained, along with preoperative weight, body mass index, Short Form 36 Health Survey and Beck Depression Inventory-II scores. For those employed, the recuperation time was also analyzed. Statistical analysis was performed using Student's t test and analysis of variance. RESULTS: Fifty-seven patients underwent RYGBP. Of the 57 patients, 41 were selected for analysis, 34% of whom were employed, with a mean recuperation time of 3.5 weeks. Their mean age was 32.4 years. The mean body mass index was 53.4 kg/m(2) preoperatively and 31.2 kg/m(2) at 5 years. Of the 41 patients, 27 (66%) were receiving disability and 25 (61%) attributed their disability to their morbidly obese state. At 5 years, 4 (16%) of the 25 were gainfully employed and no longer receiving public assistance. CONCLUSION: Despite successful long-term weight loss and improvement in quality of life, many morbid obesity patients do not return to gainful employment in the workforce after RYGBP. The mean body mass index was greater in the unemployed group at both 1 and 5 years, but the difference was not statistically significant. The socioeconomic impact of morbid obesity persists long after a reduction in weight and improvement in quality of life.     

Real-world retrospective analysis of outcomes in patients undergoing bariatric surgery with class 1 obesity

BackgroundNIH-established indications for bariatric surgery were set close to 3 decades ago.ObjectivesThe purpose of this study was to evaluate outcomes in patients undergoing bariatric surgery with class I obesity, a class that does not fall into current indications.SettingUniversity Hospital.MethodsDe-identified records from a clinic system’s Electronic Health Record database were accessed to identify adult patients undergoing Roux-en-Y gastric bypass (RYGB) (n = 566) and sleeve gastrectomy (SG) (n = 730). Patients were compared in terms of resolution of co-morbidities and weight loss outcomes at 3 years following surgery. A mixed effects model was used, adjusting for the type of surgery, the number of quarters after the surgery when the averaged measurements were taken, and the interaction between these two variables.ResultsPatients lost up to 20% of their initial body mass index (BMI). Being of younger age, female, and having an obesity-related co-morbidity were associated with greater weight loss. At around 2 years after the surgery, the likelihood of being in remission from type 2 diabetes reached 45%. Remission probabilities for hypertension are 60% for RYGB and 50% for SG, 3 years after the surgery. On the other hand, the probabilities of remission from hyperlipidemia are close to 50% and 25% for RYGB and SG at 2 years. There was no difference between the BMI trajectories and remission from type 2 diabetes (T2D) when comparing the 2 groups.ConclusionsBariatric surgery is effective in weight loss and resolution of comorbidities in patients with class I obesity. This data further supports the need to revisit the current indication criteria.     

Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery?

OBJECTIVE: To describe the dieting histories of bariatric surgery candidates. RESEARCH METHODS AND PROCEDURES: One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients' dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional. RESULTS: Participants who completed the Weight and Lifestyle Inventory reported an average of 4.7 +/- 2.9 successful dieting attempts, defined as those that resulted in a loss of 10 lbs (4.5 kg) or more. These individuals reported a mean total lifetime weight loss of 61.1 +/- 41.3 kg. Despite these efforts, their weight increased from 89.4 +/- 27.4 kg at the time of their first diet (age 21.2 +/- 10.1 years) to 144.5 +/- 30.8 kg at the time they underwent their behavioral/psychological evaluation (age 43.0 +/- 11.0 years). Results of the aided recall revealed that participants had made numerous other efforts to lose weight that were unsuccessful. Self-directed diets and commercial programs were used more frequently. DISCUSSION: Individuals who sought bariatric surgery reported an extensive history of dieting, beginning in adolescence, that was not successful in halting progressive weight gain. Thus, the recommendation often made by insurance companies that patients delay surgery to attempt more conservative treatment options may be unwarranted, particularly in the presence of significant obesity-related comorbidities. Weight loss histories should be routinely examined during a behavioral evaluation to determine whether additional attempts at non-surgical weight loss are advisable. Future studies also are needed to explore the potential relationship between dieting history and postoperative outcome.     

The impact of bariatric surgery on pulmonary function: a meta-analysis

Morbid obesity may affect several body systems and cause ill effects to the cardiovascular, hepatobiliary, endocrine, and mental health systems. However, the impact on the pulmonary system and pulmonary function has been debated in the literature. A systematic review and meta-analysis for studies that have evaluated the impact of bariatric surgery on pulmonary function were pooled for this analysis. PubMed, Cochrane, and Embase databases were evaluated through September 31, 2016. They were used as the primary search engine for studies evaluating the impact pre– and post–bariatric surgery on pulmonary function. Pooled effect estimates were calculated using random-effects model. Twenty-three studies with 1013 participants were included in the final meta-analysis. Only 8 studies had intervention and control groups with different time points, but 15 studies had matched groups with different time points. Overall, pulmonary function score was significantly improved after bariatric surgery, with a pooled standardized mean difference of .59 (95% confidence interval: .46–.73). Heterogeneity test was performed by using Cochran’s Q test (I² = 46%; P heterogeneity = .10). Subgroup analysis and univariate meta-regression based on study quality, age, presurgery body mass index, postsurgery body mass index, study design, female patients only, study continent, asthmatic patients in the study, and the type of bariatric surgery confirmed no statistically significant difference among these groups (P value>.05 for all). A multivariate meta-regression model, which adjusted simultaneously for these same covariates, did not change the results (P value > .05 overall). Assessment of publication bias was done visually and by Begg’s rank correlation test and indicated the absence of publication bias (asymmetric shape was observed and P = .34). This meta-analysis shows that bariatric surgery significantly improved overall pulmonary functions score for morbid obesity.     

The impact of laparoscopy on bariatric surgery

The rising popularity of bariatric surgery over the past several years is attributable in part to the development of laparoscopic bariatric surgery. Morbidly obese patients have associated comorbid conditions that may predispose them to postoperative morbidity. The laparoscopic approach to bariatric surgery offers a minimally invasive option that reduces the physiologic stress and provides clinical benefits, as compared with the open approach. This review summarizes the impact of laparoscopic surgery on bariatric surgery, the various risk factors that could potentially predispose morbidly obese patients to postoperative morbidity, the fundamental differences between laparoscopic and open bariatric surgery, and the physiology of reduced tissue injury associated with laparoscopic bariatric surgery.