Bariatric-metabolic surgical techniques: Mechanism, operative technique and perioperative management

Bariatric-metabolic surgery is by far the most effective treatment modality for morbid obesity. In long-term studies excellent results in weight loss and the treatment of comorbidities associated with obesity (e.g., arterial hypertension, type 2 diabetes mellitus) could be shown. Bariatric surgical procedures are based on the principles of restriction and malabsorption. The related metabolic effects, which sometimes appear in the early postoperative period independently of weight loss and calorie reduction, are the subject of intensive research. The most frequently used restrictive procedures are sleeve gastrectomy, gastric banding, gastric plication, and gastric balloon. In gastric bypass, the biliopancreatic diversion (with and without duodenal switch), and single anastomosis duodeno-ileal bypass with sleeve both principles are combined. The procedures are normally performed laparoscopically and complication rates are acceptable. Postoperatively, lifelong metabolic controls and supplementation with vitamins and micronutrients are needed to avoid malnutrition, especially after malabsorptive procedures.

Automated summary

Bariatric-metabolic surgery is the most effective treatment for morbid obesity, achieving weight loss and the treatment of associated comorbidities. The procedures are based on restriction and malabsorption principles, and have shown excellent long-term results. The surgeries are performed laparoscopically and require lifelong metabolic control and nutrient supplementation.