Gastric surgery.
Significant advances in the role of gastric surgery in the management of disease in the past year have focused on three broad areas: morbid obesity, gastric cancer, and peptic ulcer disease. Although vertical banded gastroplasty and Roux-en-Y gastric bypass are the two procedures most commonly used in the United States to induce weight loss in the morbidly obese patient, long-term follow-up continues to support the durability of the gastric bypass in maintaining a sustainable outcome with a minimum of complications. It is not surprising, therefore, that increasing interest has accrued in simplifying this operation and decreasing potential complications even further by employing laparoscopic technology. In the area of gastric cancer, several reports have provided important new information regarding its pathogenesis, factors influencing long-term survival, and strategies for management when diagnosed early. Finally, in patients developing the complications of peptic ulcer disease (eg, obstruction and perforation), conservative management has been emphasized over more radical traditional approaches. This review highlights these advances.