HOW TO CHOOSE A BARIATRIC OPERATION. IS IT POSSIBLE TO BE OBJECTIVE?
Informed consent is a an ethical request and an habit in all fields of contemporary medicine, and a legal obligation as well, particularly in surgery. Bariatric surgery is highly debated and therefore implies a strong pre-operative informed consent, as well as a detailed information on various procedures. These procedures are disputed among physicians though. Purely restrictive operations, such as laparoscopic gastric banding, face more complex ones such as gastro-jejunal bypass. These methods are totally different in their principles and their results. The procedures have to be explained thoroughly, regarding anatomical and physiological specifics, as well as the risks and potential adverse effects. One should stay simple, clear, available ... and ojective, which is not the easiest task given the different preferences each surgeon has made over the time. He may then lead his patient towards his prefered option. This is a complicated issue because there is no consensus among the surgical community so far.
Most surgeons will stick to the procedure they like more: for instance in the United States the vast majority uses the gastrojejunal bypass, whereas in Europe laparoscopic adjustable gastric banding is leading. Other surgeons propose a variety of procedures according to each case: super-obese patients or patients eating a lot of sugar food are offered a bypass rather than a lap-band. Actually it is a common finding that patients are oriented towards one type of procedure, even though several are theoretically proposed. A recent paper from a Swiss team illustrates this* (presented during the last IFSO meeting in Salamanca, Spain, September 2003). The authors demonstrate that pre-operative education has a significant influence on the patient's choice: thus many change their mind in favor of the bypass when their first choice was actually lap-banding... As a matter of fact, it is not difficult to have people change their choice once one points out the better results of the bypass in terms of weight-loss in the
long run and the absence of a foreign body (the band), as well as the feasability of the procedure through the laparoscopic approach (in the hands of expert surgeons), etc.
Is this purely objective? Let the reader make up his own mind!

* V Di Vetta, L Suter et col. Impact of preoperative teaching on surgical choice (gastric banding vs Roux-en-Y gastric bypass) of patients. Abstract for the 8th congress of the IFSO. Obesity Surgery 2003, 13: 511-583.