Systematic review of 88 included studies representing 8,920 patients found that the leak rate in LSG was significantly lower using APM staple-line reinforcement than oversewing, BPS reinforcement, or no reinforcement.

Since bariatric surgery is the only broadly successful treatment for morbid obesity, it is incumbent on all physicians to be familiar with current bariatric operations, and to understand the evolution of bariatric surgery.

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Background Standardization of the key measurements of a procedure's finished anatomic configuration strengthens surgical practice, research, and patient outcomes. A consensus meeting was organized to define standard versions of 25 bariatric metabolic procedures. Methods A panel of experts in bariatric metabolic surgery from multiple continents was invited to present technique descriptions and outcomes for 4 classic, or conventional, and 21 variant and emerging procedures. Expert panel and audience discussion was followed by electronic voting on proposed standard dimensions and volumes for each procedure's key anatomic alterations. Consensus was defined as ≥ 70% agreement. Results The Bariatric Metabolic Surgery Standardization World Consensus Meeting (BMSS-WOCOM) was convened March 22-24, 2018, in New Delhi, India. Discussion confirmed heterogeneity in procedure measurements in the literature. A set of anatomic measurements to serve as the standard version of each procedure was proposed. After two voting rounds, 22/25 (88.0%) configurations posed for consideration as procedure standards achieved voting consensus by the expert panel, 1 did not attain consensus, and 2 were not voted on. All configurations were voted on by ≥ 50% of 50 expert panelists. The Consensus Statement was developed from scientific evidence collated from presenters' slides and a separate literature review, meeting video, and transcripts. Review and input was provided by consensus panel members. Conclusions Standard versions of the finished anatomic configurations of 22 surgical procedures were established by expert consensus. The BMSS process was undertaken as a first step in developing evidence-based standard bariatric metabolic surgical procedures with the aim of improving consistency in surgery, data collection, comparison of procedures, and outcome reporting.

Metabolic surgery can cause amelioration, resolution, and possible cure of type 2 diabetes. Bariatric surgery is metabolic surgery. In the future, there will be metabolic surgery operations to treat type 2 diabetes that are not focused on weight loss. These procedures will rely on neurohormonal modulation related to the gut as well as outside the peritoneal cavity. Metabolic procedures are and will always be in flux as surgeons seek the safest and most effective operative modality; there is no enduring gold standard operation. Metabolic bariatric surgery for type 2 diabetes is more than part of the clinical armamentarium, it is an invitation to perform basic research and to achieve fundamental scientific knowledge. And the Lord God caused a deep sleep to fall upon Adam, and he slept; and he took one of his ribs, and closed up the flesh instead thereof, and the rib which the Lord had taken from man, made he a woman.. .. dGenesis 2:21-22 METABOLIC SURGERY In 1978, in the foreword to the book Metabolic Surgery (1), by author H.B. and Richard L. Varco, we defined the discipline of metabolic surgery "as the operative manipulation of a normal organ or organ system to achieve a biological result for a potential health gain." The procedure described in Genesis was an "operative manipulation" under general anesthesia on a "normal organ" to achieve a "biological result"; it was metabolic surgery. As early as 1896, bilateral oophorectomy was used to cause temporary regression of breast cancer metastases (2). The 100-year heyday of peptic, primarily duodenal, ulcer surgery, from the late 19th century to the discovery of Helicobacter pylori, involved operating on normal stomachs and vagus nerves to cure the pathologic lesion, a distal ulcer left untouched by the surgeon. This was metabolic surgery, as was the partial ileal bypass (Fig. 1) for the treatment of hypercholesterolemia, introduced in 1962 and 1963 (3,4). The partial ileal bypass was used as the intervention modality in the Program on the Surgical Control of the Hyperlipidemias (POSCH) (5-8), the first randomized controlled trial to use metabolic surgery. POSCH was the first study definitively to demonstrate the benefits of marked cholesterol lowering in preventing myocardial infarctions, peripheral vascular disease, and the need for coronary artery