Bariatric surgery is a category of general surgical procedures traditionally done by laparotomy and, because of the patient population and complexity of the procedure, it is inherently less amenable to minimally invasive surgery than most procedures attempted by general surgeons. Over the past 30 years, a variety of bariatric surgeries have been used to surgically produce weight loss in severely obese patients, but most of these have proven to have drawbacks that have limited their popularity. Two procedures that have stood the test of time and are commonly performed today by celiotomy include the vertical banded gastroplasty (VBG) and the Roux-en-Y gastric bypass (RYGB). Both have long track records for safety and effectiveness, and proponents continue to argue for one or the other as the procedure of choice. Not commonly performed, and not discussed in this article, are the biliopancreatic bypass (a malabsorptive surgery) and variants of the VBG, including Silastic ring banding procedures (which have been shown to produce outcomes similar to the VBG).

VBG and RYGB are the focus of this article, together with a new procedure, adjustable gastric banding (AGB). AGB only recently has been performed in significant numbers, with a laparoscopic approach in most series. Two types of bands have been used but they essentially function in the same fashion. The long-term applicability and effectiveness of AGB remain questionable. The instruments (gastric bands) have not yet met with US Food and Drug Administration approval for use in the United States.

Bariatric surgeons and laparoscopic surgeons have, over the past several years, combined their skills and expertise to advance the field of laparoscopic bariatric surgery. In the United States, laparoscopic bariatric surgery is in its infancy, with only a few centers enjoying significant success. In Europe, the AGB, within the past 5 years, has been performed on thousands of patients in many centers. In many European countries, AGB has replaced bariatric surgery done by celiotomy as the most popular procedure.

Bariatric surgery stands at another critical point in its development with respect to the performance of procedures laparoscopically. It is hoped that the setbacks that this field has experienced, such as with the intestinal bypass, are avoided in favor of the careful application of laparoscopic bariatric procedures using strict scientific and clinical data.