Outcomes in Bariatric and Metabolic Surgery: an Updated 5-Year Review
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HEALTH SERVICES AND PROGRAMS (R WELBOURN AND C BORG, SECTION EDITORS)
Outcomes in Bariatric and Metabolic Surgery: an Updated 5-Year Review A. E. Roth 1
&
C. J. Thornley 1 & R. P. Blackstone 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Knowledge regarding postoperative outcomes after bariatric and metabolic surgery continues to evolve. This review highlights key findings in outcomes research over the last 5 years related to weight loss, remission of obesity-related disease, reflux, revisional surgery, robotic-assisted surgical platforms, and adolescent populations. Recent Findings Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) produce similar weight loss patterns at 5 years, while duodenal switch (BPD/DS) and related procedures are associated with maximal weight loss overall and optimal resolution of obesity-related comorbidities. Remission of type 2 diabetes mellitus (T2DM) following surgery is more likely in patients who are not insulin dependent prior to surgery. Bariatric and metabolic surgery offers a significant protective effect against coronary artery disease (CAD) and associated interventions in both diabetic and nondiabetic patients, as well as heart failure (HF). Gastroesophageal reflux disease (GERD) and dysphagia following SG are common, and routine endoscopic surveillance for Barrett’s esophagus may be of significant utility. Robotic-assisted laparoscopic platforms concur similar outcomes to laparoscopic intervention, with a potential benefit in high BMI patients. Revisional surgery is most commonly performed for weight regain and/or inadequate weight loss following an index procedure, or reflux, and generally characterized by higher postoperative complication rates and longer inpatient lengths of stay (LOS). Surgical intervention in adolescent populations has similar weight loss and postoperative complication profiles to those seen in adult populations, with improved outcomes related to T2DM. Summary Bariatric and metabolic surgery continues to evolve as a treatment for obesity and obesity-related comorbidities. While effective for weight loss and remission of obesity-related disease, SG is associated with high rates of postoperative GERD. Keywords Bariatric surgery . Metabolic surgery . Outcomes . Weight loss . Type 2 diabetes mellitus (T2DM) . Gastroesophageal reflux disease (GERD)
Introduction Bariatric and metabolic surgery is a dynamic and everevolving field that has established itself as highly effective This article is part of the Topical Collection on Health Services and Programs * A. E. Roth [email protected] 1
Department of General Surgery, Banner University Medical Center – Phoenix, University of Arizona, 1441 N 12th Street, 1st floor, Phoenix, AZ 85006, USA
2
Ira A. Fulton Chair in Bariatric Surgery and Metabolic Disorders, Institute for Obesity and Metabolic Disorders, Banner University Medical Center – Phoenix, University of Arizona, 1441 N 12th Street, 1st floor, Phoenix, AZ 85006, USA
therapy for obesity and ob
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