First Edition

Foreword by President of British Obesity and Metabolic Surgery Society (BOMSS)

Obesity has become a pandemic, with billions of people across the globe now overweight or obese. This not only affects the health and longevity of each overweight person, but it also impacts massively on the economy and healthcare system in each and every country affected. As such, the management of this crisis is one of the greatest challenges facing the healthcare profession across the world.

No really successful pharmaceutical treatment currently exists and preventive measures seem just a pipe dream. This leaves bariatric surgery as the most effective tool that we have at the present time. The clinical value of such surgery is without question, and the number of bariatric operations performed has increased exponentially in recent years and continues to increase year on year.

Many different surgical procedures have been tried in the management of morbid obesity, and many different variations of each operation exist. Obesity, Bariatric and Metabolic Surgery: A Practical Guide is a major new surgical textbook, covering all aspects of obesity and its surgical management.

The book deals with the obesity epidemic, the underlying science of obesity and its health consequences. Non-surgical management of obesity is outlined, prior to an in-depth discussion of all aspects of bariatric and metabolic surgery. It describes the historical perspectives of obesity surgery, followed by a detailed discussion of patient selection and perioperative management. All of the different surgical techniques and variations of technique are described, each written by world experts in the field. It deals with the metabolic effects of bariatric surgery, and contains chapters dealing with the training, reporting and practice of bariatric surgery, finishing with many miscellaneous topics related to the field.

Not only is this textbook the perfect guide for the bariatric surgeon, but it will also act as a reference guide for physicians, family doctors and other healthcare professionals, such as dieticians and specialist nurses.

Sanjay Agrawal must be congratulated on putting together and editing what is undoubtedly the most modern and comprehensive textbook on the subject of the surgical treatment of obesity. He has bought together an amazing array of world renowned experts, each of whom has contributed chapters to the book. Looking at the list of authors is like reading a list of Who’s Who in Obesity Surgery across the globe!

This book is set to become the worldwide reference guide to obesity and bariatric and metabolic surgery.

Roger Ackroyd, MD, FRCS
Consultant Upper GI and Bariatric Surgeon
Sheffield, UK

Foreword by President of International Federation of Surgery for Obesity and Metabolic Disorders (IFSO)

It is a great honor for me as the current President of the International Federation of Surgery for Obesity and Metabolic Disorders (IFSO) to be requested to write the foreword for this book Obesity, Bariatric and Metabolic Surgery: A Practical Guide.

Obesity has been declared a worldwide epidemic. The etiology of obesity is highly complex and multifactorial encompassing genetic, environmental, physiologic, cultural, political, and socioeconomic factors. This makes it a challenge to develop effective interventions to prevent and manage obesity. The key solution for this epidemic is the prevention of obesity. However, once morbid obesity develops, bariatric or metabolic surgical intervention is the most effective and long-lasting treatment.

The editor of the book, Mr. Sanjay Agrawal from Homerton University Hospital, London, United Kingdom, has been able to collaborate with and motivate a large number of experts from around the world to contribute for the contents of the book. He has organized the time- limited submission and painstakingly reviewed all chapters to give the book its final shape.

A total of 152 authors from across the globe with practical experiences in the surgical and endoscopic treatment of obesity have elaborated upon the different aspects of obesity and its surgical management. The ever-increasing number of publications from across the world in the field of metabolic or bariatric surgery is an indicator of the rapid growth of this field of modern medicine.

Through 78 chapters, spread across 14 sections, this book offers a concise summary of obesity and its surgical management for a wide range of healthcare professionals involved within a multidisciplinary team such as surgeons, anesthetists, physicians, dietitians, psychologists, radiologists, and nursing staff. The 14 sections were edited mainly by surgeons and scientists from the United Kingdom. The chapters themselves were written by international experts in the field from 20 countries covering five different continents. This makes the book an excellent reference guide for physicians, surgeons, and general practitioners.

Besides the basic fundamentals, pathophysiology and surgical techniques for morbid obesity, other important practical aspects are also discussed in detail. These include the credentials for training in the field of metabolic surgery, the quality control of bariatric surgery services, and the data management and reporting systems used worldwide. Medico-legal issues that play an important role in metabolic surgery are described in a special chapter. The spectrum of actual procedures in the field of bariatric and metabolic surgery is completely represented in this book. Online videos for many of the procedures make this book an excellent training tool as well.

The well-documented therapeutic effects of metabolic/bariatric surgery on several obesity- related diseases, the increased life expectancy after weight-loss surgery and the fact that surgery is more cost-effective than nonsurgical management are likely to change the indications for such surgeries in the future.

Surgery for morbid obesity involves surgical manipulation of normal body parts to get a biological result that can potentially cause weight loss and arrest weight regain. Hence, such surgery is considered as metabolic surgery. The actual body weight and the body mass index are not the sole indications for surgery. Henry Buchwald, who first coined the term metabolic surgery said, “Metabolic surgery is cognitive surgery.” The realization that bariatric surgery is

actually metabolic surgery is, however, relatively new. The term bariatric is expected to be changed to metabolic surgery in the future. The future of this field is extremely bright and rapid advancements likely to happen. Therefore, we can expect a second edition soon.

Rudolf A. Weiner, MD, PhD
Professor of Surgery at University of Frankfurt am Main, Germany
Head of the Obesity Center Sana-Klinikum Offenbach am Main, Germany

Foreword by Pradeep Chowbey

Obesity is the modern-day scourge of mankind. The obesity epidemic is sweeping across nations, regions, and continents. There are enormous implications of the obesity pandemic for the affected population and health care delivery systems globally. Increasingly large segments of obese population have to contend with declining health parameter, poorer quality of life, and increased costs of health care.

The management of obesity is complex and involves several medical and surgical disci- plines. Bariatric is an area of health care that epitomizes importance of teamwork and synergy in providing optimal health care delivery. Bariatric surgery today has evolved into a highly specialized surgical discipline in the short span of a few decades. Bariatric surgeons worldwide are a busy lot and the tribe is expanding in an effort to keep pace with demand.

On browsing through the list of contents of Dr. Agrawal’s textbook, it is apparent that this is a textbook that is comprehensive, broad based, and yet exhaustive. The initial section of the textbook comprises an introduction to the problem of obesity and metabolic syndrome, the rationale and case for bariatric surgery, preoperative assessment, anesthetic considerations, and perioperative management of the bariatric patient. The subsequent sections describe the standard bariatric surgical procedures in elaborate detail as also different approaches like sin- gle incision bariatric surgery. Also included are complex situations like revisional surgery and some less commonly performed bariatric procedures. Newer endoscopic approaches and pure metabolic surgical procedures are described.

The expanse and scope of this textbook is immense. I cannot think of an important and relevant subject in bariatric surgery that has not been covered. I think this textbook would serve as a useful reference book for the armchair academic, the novice, and the experienced bariatric surgeon. I am impressed with the list of contributors that includes several leading practitioners in bariatric surgery.

I believe Dr. Agrawal’s textbook will provide a reference and insight into the state-of-art information and knowledge on bariatric surgery as it exists today. I wish him the best for the current and all future endeavors.

Dr. Pradeep Chowbey
Max Institute of Minimal Access
Metabolic and Bariatric Surgery
Max Healthcare Institute Ltd.
New Delhi, India

President– International Federation for the Surgery of Obesity and Metabolic Disorders
(IFSO) 2012–2013
Asia Pacific Chapter of IFSO (IFSO-APC) 2011–2013
Asia Pacific Metabolic & Bariatric Surgery Society (APMBSS) 2010–2012
Obesity & Metabolic Surgery Society of India (OSSI) 2006–2010