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  • Review Article
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Bariatric surgery for obesity and metabolic disorders: state of the art

Nature Reviews Gastroenterology & Hepatology volume 14, pages 160–169 (2017)Cite this article

Subjects

Key Points

  • Obesity continues to be a major public health problem worldwide

  • Bariatric surgery is an effective treatment for severe obesity that results in the improvement or remission of many obesity-related comorbid conditions, as well as sustained weight loss and improvement in quality of life

  • The four most common bariatric operations performed worldwide are laparoscopic sleeve gastrectomy, laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and duodenal switch

  • Bariatric surgery is now safe, with mortality comparable to common elective general surgical operations

  • Level 1 evidence show that bariatric surgery provides superior short-term and long-term weight loss and improvement of type 2 diabetes mellitus compared with conventional medical therapy

  • Newly approved laparoscopic and endoscopic devices are now available for management of patients with obesity; however, the long-term efficacy of these devices is unknown

Abstract

Obesity is one of the most important public health conditions worldwide. Bariatric surgery for severe obesity is an effective treatment that results in the improvement and remission of many obesity-related comorbidities, as well as providing sustained weight loss and improvement in quality of life. Contemporary bariatric operations include Roux-en-Y gastric bypass, sleeve gastrectomy, adjustable gastric band and the duodenal switch. The vast majority of these procedures are now performed using laparoscopic technique, the main advantages of which include rapid recovery, the reduction of postoperative pain and the reduction of wound-related complications, compared with open surgery. Contemporary bariatric surgery is now safe, with a mortality of three in 1,000 patients; however, all bariatric operations are associated with their own unique short-term and long-term nutritional and procedural-related complications. Type 2 diabetes mellitus (T2DM) is the most studied metabolic disorder associated with obesity, with data demonstrating that improvement and remission of T2DM in patients with obesity is superior after bariatric surgery compared with conventional medical therapy. Bariatric surgery is now a part of some treatment algorithms for the medical management of patients with T2DM and severe obesity. New, minimally invasive and endoscopic devices for the treatment of obesity have now been approved in the USA, which will expand the treatment options for individuals with obesity.

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Figure 1: Common bariatric surgical procedures.
Figure 2: New bariatric procedures.

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Author information

Authors and Affiliations

  1. Department of Surgery, University of California Irvine Medical Center, 333 City Boulevard West, Suite 1600, Orange, 92868, California, USA

    Ninh T. Nguyen

  2. Diabetes Surgery Institute, 8025 Bonhomme Avenue, Clayton, St. Louis, 63105, Missouri, USA

    J. Esteban Varela

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  1. Ninh T. Nguyen
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  2. J. Esteban Varela
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The authors contributed equally to this Review.

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Correspondence to Ninh T. Nguyen.

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Nguyen, N., Varela, J. Bariatric surgery for obesity and metabolic disorders: state of the art. Nat Rev Gastroenterol Hepatol 14, 160–169 (2017). https://doi.org/10.1038/nrgastro.2016.170

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