Over the past few decades obesity has become an important health problem. This problem mainly relates to well developed countries. To a greater extent, it is also becoming crucial in Poland. Obesity is accompanied by disturbances associated with overweight such as type 2 diabetes mellitus, dyslipidemia, hypertension, circulatory system diseases, obesity hypoventilation syndrome and degenerative lesions of the osteoarticular system. Conservative treatment, which mainly includes modification of existing eating habits and daily physical activity, usually does not provide any permanent effect. In the majority of patients in the long-term prospective, maintaining a beneficial relationship between the amount of energy intake and expenditure fails. In addition, implementation of fully effective pharmacological measures, which allow effective treatment of pathological obesity, has not been successful so far. After body mass reduction achieved by conservative treatment, patients manifest increased appetite, disturbed evaluation of the amount of consumed food and a tendency to consume high calorie foods (1, 2). After body mass reduction in obese patients, consuming large amount of food does not affect hunger and it does not provide feeling of fullness to such extent as it does in case of persons with normal body mass (3). Surgical treatment is an attractive alternative mainly because of the degree of body mass reduction and the permanency of obtained effects (4). It was also shown that surgical treatment is more beneficial compared to conservative treatment in terms of remission in comorbidities (5, 6). Over the past decade, the number of performed bariatric surgeries significantly increased. This phenomenon was undoubtedly affected by development of laparoscopic techniques and continuously increasing awareness of this problem, not only among patients, but also among physicians (7). In 2011 – 340,768 bariatric procedures were performed all over the world. This is a significant increase compared to 2003, when there was only 146,301 surgeries performed. The most frequently performed surgery was Roux-en-Y gastric bypass (RYGB) – 46.6%, sleeve gastrectomy – 27.8% (SG), adjustable gastric banding (AGB) – 17.8% and biliopancreatic diversion with duodenal switch (BPD – DS) – 2.2%. In the same paper, tendencies regarding a change in the percent share of the respective types of surgeries in the general number of bariatric procedures were evaluated. Data collected in 2003, 2008 and 2011 were compared. A downward tendency was noted in the case of Roun-en-Y gastric bypass, 65.1, 49.0 and 46.6%, respectively, and in the case of biliopancreatic diversion, 6.1, 4.9 and 2.1%, respectively. In 2011, there was a significant increase in the percent share of sleeve gastrectomy in the general number of conducted surgeries, from 0.0 through 5.3 to 27.89%, respectively. In the case of adjustable gastric banding, after an initial increase from 24.4% in 2003 to 42.3% in 2008, a decrease took place in 2011 to 17.8%. The most surgeries were performed in the U.S. and in Canada – 101,645, in Brazil – 65,000, in France – 27,648 and in Mexico – 19,000. In 2011, 1,250 surgeries were performed in Poland. The number of the respective types of surgeries performed in our country were as follows: adjustable gastric banding – 256, sleeve gastrectomy – 516, Roun-en-Y gastric bypass – 381, mini gastric bypass – 65, biliopancreatic diversion – 5, biliopancreatic diversion with duodenal switch – 3, banded gastroplasty – 10, other – 14. The proportion of the number of surgical procedures to the number of citizens in Poland was 0.0033 and the same proportion in the U.S. and in Canada – 0.0326 and in Belgium – 0.7722 (8).

The generally adopted qualification criteria for surgical treatment include: BMI > 40 kg/m² or BMI 35-40 kg/m² and the coexistence of at least one obesity-dependant diseases such as: hypertension, type 2 diabetes mellitus, severe sleep apnea syndrome, dyslipidemia and motor organ diseases resulted in limiting mobile activity. In a majority of centers, patients in the age of 18-60 are qualified for surgical treatment. Additional conditions to be met if surgical methods are used include a patient’s complete understanding of the purposes and principles of surgical treatment, informed consent for treatment, approval for the type of proposed treatment, willingness to constantly cooperate during the postoperative period and a lack of general contraindications for surgical procedure and general anesthesia. In the case of body mass index 30-35 kg/m², indications for surgical treatment should be individually determined depending on the type of comorbidities. It is also possible to qualify patients below 18 years of age for surgical treatment (9). In the case of patients over 60 years old, the qualification for the procedure takes place after evaluating the balance between the benefits and risk of complications. In these patients, surgical treatment may be used, but rather to achieve a better quality of life but not for the purpose to extend their lives. Currently, past attempts of using conservative treatment are not a necessary condition to qualify for surgical treatment. Sometimes it is questionable what weight should be assumed for the calculation of the body mass index, which would be the base to qualify for surgical treatment. In some centers, the highest weight reached by the patient is considered. The most frequently, however, qualification is made on the base of current body mass. It should be kept in mind that the reduction of body mass, which takes place during the preparation period before the surgical procedure, should not result in changing the qualification for treatment.

The main mechanisms leading to body mass reduction as a result of surgical treatment include limiting the volume of consumed food and limiting its absorption. The action of each of these factors leads to a decrease in energy value of absorbed food. Restrictive surgeries, i.e. limiting the volume of consumed food, include: gastric plication, vertical banded gastroplasty (currently performed less often), placement of adjustable gastric banding and sleeve gastrectomy. Recently, reports have been published regarding endoscopic methods using restrictive mechanisms. These methods include transoral vertical gastroplasty. Surgical procedures, which use both mentioned mechanisms, i.e. restrictive and malabsorptive procedures, include: Roux-en-Y gastric bypass, mini gastric bypass and biliopancreatic diversion with duodenal switch. Procedures with malabsorption as the main mechanism of action include biliopancreatic diversion. Presently, each of these surgeries may be performed using the laparoscopic method. A perfect bariatric surgery should be safe, easy to perform, and lead to significant body weight loss, a high level of patient’s satisfaction and minimum pain in the postoperative period. The level of early and late complications should be low. The duration of a procedure and hospitalization period should be short, and convalescence as well as return to professional activity should be fast. Achieved body mass reduction should be permanent and the achieved results should be easy to evaluate. A given method should not lead to nutritional deficiencies, and in case of their occurrence, treatment should be relatively easy. The surgery should be performed by an experienced surgeon involved in bariatric or metabolic surgery (10). An overview of the most frequently performed bariatric surgeries with consideration of some interesting methods introduced in recent years is presented below.