Procedure and patient selection in bariatric and metabolic surgery

Abstract

Introduction: Sleeve Gastrectomy (SG), Roux-en-Y Gastric Bypass (RYGB), and One Anastomosis Gastric Bypass (OAGB) are the commonest bariatric procedures performed worldwide. The purpose of this review was to analyse comparative data on these three procedures to aid patient and procedure selection for patients seeking Bariatric and Metabolic Surgery (BMS). Evidence Acquisition: We examined published English language scientific literature available on PubMed for data comparing SG, RYGB, and OAGB for various groups of patients. Evidence Synthesis: There are a number of variables that can influence patient and procedure selection for individuals seeking BMS. High-quality data comparing each of these procedures for every patient subgroup, for each possible outcome measure is lacking. It is, therefore, not currently possible to make strict recommendations regarding patient and procedure selection. At the same time, the multidisciplinary teams should understand that risks of surgery may simply be too high for some patients-such as those suffering from end-stage organ disease and those suffering from mega obesity (BMI ≥ 70 kg/m 2). Surgery should only be offered to such high-risk groups in dedicated centres with appropriate expertise. For other patients, surgeons should carefully consider the pros and cons of each procedure, their own experience, and patient preferences before deciding the most appropriate BMS procedure for them. Conclusion: This review examines various factors influencing patient and procedure selection in bariatric surgery. Authors feel it is currently not possible to make strict recommendations and surgeons should carefully discuss the pros and cons of bariatric surgery and that of various options available in their practice with the patients before making a final recommendation.

Weight Loss After Bariatric Surgery in Morbidly Obese End-Stage Kidney Disease Patients as Preparation for Kidney Transplantation. Matched Pair Analysis in a High-Volume Bariatric and Transplant Center

“…Third, follow-up was limited to 1 year, thus long-term results of bariatric surgery in that group of patients were not analyzed. Lastly, three different bariatric procedures are included in analysis, which blurs the difference of outcome related to procedure type [37]. Research aimed to indicate the most effective type of bariatric surgery in ESKD patients is needed.…”

Obesity in work-up of kidney transplant candidates – review of clinical practice guidelines.

“…However the safety and significance of weight loss surgery in ESKD patients increased over the years [25,[37][38][39]. Two bariatric procedures were preferred [23,40]. LSG (laparoscopic sleeve gastrectomy) and LRYGB (laparoscopic roux-en-y gastric bypass) appear to cause effective weight-loss before KT and improve surgical access during transplantation [41][42].…”