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, 9 (2), R28-R35

The Metabolic Benefits of Different Bariatric Operations: What Procedure to Choose?


The Metabolic Benefits of Different Bariatric Operations: What Procedure to Choose?

Alexis Sudlow et al. Endocr Connect.


Bariatric surgery is established as a highly effective treatment for obesity and related metabolic complications. Although once seen as a last resort for patients with obesity, given the data demonstrating the profound weight loss, improvement in comorbidity and safety, perceptions have since shifted. There is evidence from 12 RCTs demonstrating its safety and efficacy in terms of weight loss which is sustained in the long term with a resultant improvement in co-morbidity. Clinicians are increasingly recognising the importance of timely intervention to maximise the effects of bariatric surgery, particularly in light of the low likelihood of being able to adequately manage patients with medication or lifestyle interventions alone. The inclusion of bariatric surgery in the standard treatment algorithm has been a step forward in the approach to treating patients with obesity. What remains challenging for clinicians is knowing which procedure is most beneficial to patients. There is no level one data demonstrating the superiority of one procedure over another. Head to head RCTs are ongoing which may shed light on this question; however, it is likely that there is no single procedure that will be demonstrated to be the gold standard. Herein we review the most commonly performed procedures along with the evidence available to support their effects with regards to weight loss and metabolic changes along with their limitations and recognised risks. The aim is to provide a general framework to allow clinicians to take advantage of the variety of operative approaches to tailor their treatment strategy to the individual patient.

Keywords: diabetes; gastrointestinal tract; metabolism; obesity.

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    1. Welbourn R, Hollyman M, Kinsman R, Dixon J, Liem R, Ottosson J, Ramos A, Våge V, Al-Sabah S, Brown W, et al Bariatric surgery worldwide: baseline demographic description and one-year outcomes from the fourth IFSO Global Registry Report 2018. Obesity Surgery 2019. 782–795. (10.1007/s11695-018-3593-1) - DOI - PubMed
    1. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, King WC, Wahed AS, Berk P, Chapman W, Pories W, Courcoulas A, McCloskey C, et al Perioperative safety in the longitudinal assessment of bariatric surgery. New England Journal of Medicine 2009. 445–454. (10.1056/NEJMoa0901836) - DOI - PMC - PubMed
    1. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, et al Effects of bariatric surgery on mortality in Swedish obese subjects. New England Journal of Medicine 2007. 741–752. (10.1056/NEJMoa066254) - DOI - PubMed
    1. Dixon JB, O’Brien PE, Playfair J, Chapman L, Schachter LM, Skinner S, Proietto J, Bailey M, Anderson M. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA 2008. 316–323. (10.1001/jama.299.3.316) - DOI - PubMed
    1. Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, Brethauer SA, Navaneethan SD, Singh RP, Pothier CE, Nissen SE, et al Bariatric surgery versus intensive medical therapy for diabetes – 5-year outcomes. New England Journal of Medicine 2017. 641–651. (10.1056/NEJMoa1600869) - DOI - PMC - PubMed

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