The metabolic benefits of different bariatric operations: what procedure to choose?

Abstract

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.

A Longitudinal Study of the Antioxidant Barrier and Oxidative Stress in Morbidly Obese Patients after Bariatric Surgery. Does the Metabolic Syndrome Affect the Redox Homeostasis of Obese People?

“…Nowadays, bariatric surgery is the most efficient method of obesity treatment [12]. Many studies have shown that bariatric surgery not only helps patients achieve long-term weight loss but also removes obesity-related complications, including T2DM and high blood pressure [13][14][15][16].…”

Obesity and SARS-CoV-2: Considerations on bariatric surgery and recommendations for the start of surgical activity

“… 6 , 7 It is known that bariatric surgery is a safe, effective treatment that is indicated in people with morbid obesity and type II obesity with associated serious comorbidities, such as type 2 diabetes mellitus (DM2), arterial hypertension (HTN) or obstructive sleep apnea (OSA). 8 , 9 Therefore, bariatric surgery should be included in the structured waiting lists with the commitment of the autonomous communities to guarantee a delay of no more than 6 months, as is done with other benign surgical pathologies. 10 …”

Impact of Weight Loss on the Total Antioxidant/Oxidant Potential in Patients with Morbid Obesity—A Longitudinal Study

“…It is also insufficient in patients with morbid obesity (body mass index (BMI) > 40 kg/m 2 ). Thus, the most effective method of treatment for morbid obesity is bariatric surgery [9]. Of the many surgical techniques, the most popular bariatric procedures are sleeve gastrectomy and Roux-en-Y gastric bypass [10].…”