Bariatric Surgery: Surgical Options and Outcomes
- Bariatric surgery should be considered for patients with severe obesity (body mass index (BMI) ≥ 35 kg/m2) and obesity-related diseases, or BMI ≥ 40 kg/m2 without obesity-related diseases.
- Bariatric surgery could be considered for patients with obesity (BMI ≥ 30 kg/m2) with severe obesity-related diseases not responding to medical management.
- The choice of bariatric procedure should be tailored to patients’ needs, in collaboration with a multidisciplinary team and based on the discussion of risks, benefits and side-effects.
- Several procedures are currently performed in Canada (adjustable gastric banding, sleeve gastrectomy, gastric bypass, duodenal switch and others) but variations exist.
- For patients with severe obesity, surgery offers superior outcomes compared to best medical management, in terms of quality of life, long-term weight loss and resolution of obesity-related diseases, especially type 2 diabetes, sleep apnea, fatty liver disease and hypertension.
- Laparoscopic approach should be standard and is associated, for most patients, with a low mortality rate (< 0.1%) and low serious complication rate (< 5%).
- Bariatric surgery improves life expectancy.
- Novel surgical and endoscopic approaches are being used and developed and can represent an option for specific patients.
- Bariatric surgery can be considered for people with BMI ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 with at least one adiposity-related disease to (Level 4, Grade D, Consensus) to:
- Reduce long-term overall mortality (Level 2b, Grade B);
- Induce significantly better long-term weight loss compared to medical management alone (Level 1a, Grade A);
- Induce control and remission of type 2 diabetes, in combination with best medical management, over best medical management alone (Level 2a, Grade B);
- Significantly improve quality of life (Level 3, Grade C);
- Induce long-term remission of most obesity-related diseases, including dyslipidemia (Level 3, Grade C),7 hypertension (Level 3, Grade C), liver steatosis and nonalcoholic steatohepatitis (Level 3, Grade C).
- Bariatric surgery should be considered in patients with poorly controlled type 2 diabetes and Class I obesity (BMI between 30 and 35 kg/m2) (Level 1a; Grade A) despite optimal medical management.
- Bariatric surgery may be considered for weight loss and/or to control adiposity-related diseases in persons with Class 1 obesity, in whom optimal medical and behavioural management have been insufficient to produce significant weight loss (Level 2a, Grade B).
- We suggest the choice of bariatric procedure (sleeve gastrectomy, gastric bypass or duodenal switch) be decided according to the patient’s need, in collaboration with an experienced interprofessional team (Level 4, Grade D, Consensus).
- We suggest that adjustable gastric banding not be offered due to unacceptable complications and long-term failure (Level 4, Grade D).
- We suggest that single-anastomosis gastric bypass not be routinely offered, due to long-term complications in comparison with standard Roux-en-Y gastric bypass (Level 4, Grade D).
- If you are suffering from severe obesity, you should enquire about bariatric surgery. In your situation, behavioural interventions and medical therapies are important but usually not effective enough to obtain significant long-term weight loss and remission of obesity-related diseases.
- Bariatric surgery in combination with modifications to health behaviours can result in significant long-term weight loss (20% to 40% of your body weight) and control, or, in some cases, complete remission, of obesity-related diseases, including type 2 diabetes, sleep apnea, fatty liver disease and hypertension.
- Different surgical options exist (e.g., sleeve gastrectomy, gastric bypass and duodenal switch), with different levels of effectiveness. You should have an extensive discussion with the surgical team before deciding which surgical option seems to be the best for you.
- All surgeries have some adverse effects and potential risks, and require lifelong management to follow-up, mineral and vitamin supplementations, and behavioural changes.