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VOLUME 55 , ISSUE 2 ( April-June, 2021 ) > List of Articles


Surgical Management of Obesity: A Broad Overview of Bariatric and Metabolic Surgery

Aditya A Kulkarni, Uttam A Thakur, Naveen A Kumar, Venu Bhargav, Pavan Kumar, Ashu Rastogi, Praveen M Kumar, Rajesh Gupta

Keywords : Bariatric surgery, Metabolic surgery, Obesity, Sleeve gastrectomy

Citation Information : Kulkarni AA, Thakur UA, Kumar NA, Bhargav V, Kumar P, Rastogi A, Kumar PM, Gupta R. Surgical Management of Obesity: A Broad Overview of Bariatric and Metabolic Surgery. J Postgrad Med Edu Res 2021; 55 (2):83-90.

DOI: 10.5005/jp-journals-10028-1435

License: CC BY-NC 4.0

Published Online: 00-06-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Obesity is the second leading preventable cause of death globally. India has the dubious distinction of housing the third-highest number of obese people in the world. Obesity leads to several comorbid conditions that practically affect every organ of the body. Long-term results of medical therapy and lifestyle interventions for morbid obesity are dismal. Bariatric surgery has proven to be superior to medical therapy in terms of weight loss and resolution of comorbidities. Bariatric metabolic surgery may be offered to patients with body mass index (BMI) ≥37.5 kg/m2, with or without any obesity-related comorbidity, or BMI ≥32.5 kg/m2 with two or more obesity-related comorbidities. Surgery for morbid obesity would not be indicated if patients do not show a desire to adhere to long-term dietary advice or take nutritional supplements. Bariatric procedures can be classified into three types: mainly restrictive [vertical banded gastroplasty (historical), adjustable gastric banding, sleeve gastrectomy], mainly malabsorptive (duodenal switch, biliopancreatic diversion), and a combination of the two (gastric bypass). With advances in technology and the demand for less invasive weight loss therapy, all the above-mentioned procedures can be performed laparoscopically or with a robot. Endoscopic procedures and devices including intragastric balloons, endoluminal suturing, aspiration systems, and many other experimental therapies are also being tried. Post-bariatric surgery, patients have to follow a strict dietary regimen and take supplements lifelong. This review article provides a broad overview of surgical treatment of obesity and metabolic syndrome.

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  1. Ng M, Fleming T, Robinson M, et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013; 2013: a systematic analysis for the global burden of disease study 2013. Lancet 2014;384(9945):766–781.
  2. Misra A, Chowbey P, MakkarBM, et al. Consensus statement for diagnosis of obesity, abdominal obesity and the metabolic syndrome for Asian Indians and recommendations for physical activity, medical and surgical management. J Assoc Physicians India 2009;57:163–170.
  3. Donnelly JE, Blair SN, Jakicic JM, et al. American College of Sports Medicine position stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 2009;41(2):459–471.
  4. Sacks FM, Bray GA, Carey VJ, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Engl J Med 2009;360(9):859–873.
  5. Williams DM, Nawaz A, Evans M. Drug therapy in obesity: a review of current and emerging treatments. Diab Ther 2020;11:1199–1216. DOI: 10.1007/s13300-020-00816-y.
  6. Glandt M, Raz I. Present and future: pharmacologic treatment of obesity. J Obes 2011;2011:636181.
  7. Franz MJ, VanWormer JJ, Crain AL, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Dietetic Asso 2007;107(10):1755–1767.
  8. Sjöström L. Review of the key results from the swedish obese subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. J Int Med 2013;273(3):219–234.
  9. Sjöström L, Narbro K, Sjöström CD, et al. Effects of bariatric surgery on mortality in swedish obese subjects. N Engl J Med 2007;357(8):741–752.
  10. Palikhe G, Gupta R, Behera BN, et al. Efficacy of laparoscopic sleeve gastrectomy and intensive medical management in obese patients with type 2 diabetes mellitus. Obes Surg 2014;24(4):529–535.
  11. Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. J Am Med Asso 2008;299(3):316–323.
  12. Ikramuddin S, Korner J, Lee WJ, et al. Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the diabetes surgery study randomized clinical trial. J Am Med Asso 2013;309(21):2240–2249.
  13. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes - 5-year outcomes. N Engl J Med 2017;376(7):641–651.
  14. Gloy VL, Briel M, Bhatt DL, et al. Bariatric surgery versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomised controlled trials. Br Med J 2013;347:f5934.
  15. Wu G-Z, Cai B, Yu F, et al. Meta-analysis of bariatric surgery versus non-surgical treatment for type 2 diabetes mellitus. Oncotarget 2016;7(52):87511–87522.
  16. Dixon JB, Zimmet P, Alberti KG, et al. International diabetes federation taskforce on E, Prevention. Bariatric surgery: an IDF statement for obese type 2 diabetes. Diabet Med 2011;28(6):628–642.
  17. Thakur U, Bhansali A, Gupta R, et al. Liraglutide augments weight loss after laparoscopic sleeve gastrectomy: a randomised, double-blind, placebo-control study. Obes Surg 2021;31(1):84–92. DOI: 10.1007/s11695-020-04850-4.
  18. Bhasker AG, Prasad A, Raj PP, et al. OSSI (obesity and metabolic surgery society of india) guidelines for patient and procedure selection for bariatric and metabolic surgery. Obes Surg 2020;30(6):2362–2368.
  19. Lennerz BS, Wabitsch M, Lippert H, et al. Bariatric surgery in adolescents and young adults--safety and effectiveness in a cohort of 345 patients. Int J Obes 2014;38(3):334–440.
  20. Susmallian S, Raziel A, Barnea R, et al. Bariatric surgery in older adults: should there be an age limit? Medicine 2019;98(3):e13824.
  21. Catheline JM, Bihan H, Le Quang T, et al. Preoperative cardiac and pulmonary assessment in bariatric surgery. Obes Surg 2008;18(3):271–277.
  22. Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology 2008;108(5):812–821.
  23. Mechanick JI, Youdim A, Jones DB, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient--2013 update: cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity 2013;21(Suppl 1 (0 1)):S1-27.
  24. Reoch J, Mottillo S, Shimony A, et al. Safety of laparoscopic vs open bariatric surgery: a systematic review and meta-analysis. Arch Surg 2011;146(11):1314–1322.
  25. Singhal R, Kitchen M, Ndirika S, et al. The “Birmingham stitch”--avoiding slippage in laparoscopic gastric banding. Obes Surg 2008;18(4):359–363.
  26. O’Brien PE, MacDonald L, Anderson M, et al. Long-term outcomes after bariatric surgery: fifteen-year follow-up of adjustable gastric banding and a systematic review of the bariatric surgical literature. Ann Surg 2013;257(1):87–94.
  27. Angrisani L, Santonicola A, Iovino P, et al. Bariatric surgery and endoluminal procedures: IFSO worldwide survey 2014. Obes Surg 2017;27(9):2279–2289.
  28. Gagner M. The future of sleeve gastrectomy. Eur Endocrinol 2016;12(1):37–38.
  29. Ramos AC, Bastos EL, Ramos MG, et al. Technical aspects of laparoscopic sleeve gastrectomy. Arq Bras Cir Dig 2015;28(Suppl 1):65–68.
  30. Delporte C. Structure and physiological actions of ghrelin. Scientifica (Cairo) 2013;2013:518909.
  31. Falken Y, Hellstrom PM, Holst JJ, et al. Changes in glucose homeostasis after roux-en-Y gastric bypass surgery for obesity at day three, two months, and one year after surgery: role of gut peptides. J Clin Endocrinol Metab 2011;96(7):2227–2235.
  32. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis 2009;5(4):469–475.
  33. Misra S, Bhattacharya S, Saravana Kumar S, et al. Long-term outcomes of laparoscopic sleeve gastrectomy from the Indian subcontinent. Obes Surg 2019;29(12):4043–4055.
  34. Gill RS, Birch DW, Shi X, et al. Sleeve gastrectomy and type 2 diabetes mellitus: a systematic review. Surg Obes Relat Dis 2010;6(6):707–713.
  35. Rawlins L, Rawlins MP, Brown CC, et al. Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis 2013;9(1):21–25.
  36. Sarkhosh K, Birch DW, Sharma A, et al. Complications associated with laparoscopic sleeve gastrectomy for morbid obesity: a surgeon's guide. Can J Surg 2013;56(5):347–352.
  37. Kumar P, Yau HV, Trivedi A, et al. Global variations in practices concerning roux-en-Y gastric bypass-an online survey of 651 bariatric and metabolic surgeons with cumulative experience of 158,335 procedures. Obes Surg 2020;30(11):4339–4351.
  38. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric SurgeryA systematic review and meta-analysis. J Am Med Asso 2004;292(14):1724–1737.
  39. Peterli R, Wölnerhanssen BK, Peters T, et al. Effect of laparoscopic sleeve gastrectomy vs laparoscopic roux-en-Y gastric bypass on weight loss in patients with morbid obesity: the SM-BOSS randomized clinical trial. J Am Med Asso 2018;319(3):255–265. DOI: 10.1001/jama.2017.20897.
  40. Yaghoubian A, Tolan A, Stabile BE, et al. Laparoscopic roux-en-Y gastric bypass and sleeve gastrectomy achieve comparable weight loss at 1 year. Am Surg 2012;78(12):1325–1328.
  41. Griffith PS, Birch DW, Sharma AM, et al. Managing complications associated with laparoscopic roux-en-Y gastric bypass for morbid obesity. Can J Surg 2012;55(5):329–336.
  42. Lee WJ, Yu PJ, Wang W, et al. Laparoscopic roux-en-Y versus mini-gastric bypass for the treatment of morbid obesity: a prospective randomized controlled clinical trial. Ann Surg 2005;242(1):20–28.
  43. Disse E, Pasquer A, Espalieu P, et al. Greater weight loss with the omega loop bypass compared to the roux-en-Y gastric bypass: a comparative study. Obes Surg 2014;24(6):841–846.
  44. Quan Y, Huang A, Ye M, et al. Efficacy of laparoscopic mini gastric bypass for obesity and type 2 diabetes mellitus: a systematic review and meta-analysis. Gastro Res Pract 2015;2015:152852.
  45. Kular KS, Manchanda N, Rutledge R. A 6-year experience with 1,054 mini-gastric bypasses-first study from Indian subcontinent. Obes Surg 2014;24(9):1430–1435.
  46. Kumar N. Weight loss endoscopy: development, applications, and current status. World J Gastroenterol 2016;22(31):7069–7079.
  47. de Castro ML, Morales MJ, Martínez-Olmos MA, et al. Safety and effectiveness of gastric balloons associated with hypocaloric diet for the treatment of obesity. Rev Esp Enf Digest 2013;105(9):529–536.
  48. Genco A, Bruni T, Doldi SB, et al. BioEnterics intragastric balloon: the Italian experience with 2,515 patients. Obes Surg 2005;15(8):1161–1164.
  49. Sharaiha RZ, Kedia P, Kumta N, et al. Initial experience with endoscopic sleeve gastroplasty: technical success and reproducibility in the bariatric population. Endoscopy 2015;47(2):164–166.
  50. Abu Dayyeh BK, Acosta A, Camilleri M, et al. Endoscopic sleeve gastroplasty alters gastric physiology and induces loss of body weight in obese individuals. Clin Gastroenterol Hepatol 2017;15(1):37–43.e1.
  51. Chang SH, Stoll CR, Song J, et al. The effectiveness and risks of bariatric surgery: an updated systematic review and meta-analysis, 2003-2012. JAMA Surg 2014;149(3):275–287.
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