Obesity Surgery

, Volume 23, Issue 4, pp 427–436 | Cite as

Metabolic/Bariatric Surgery Worldwide 2011

Research

Abstract

Background

Metabolic/bariatric procedures for the treatment of morbid obesity, as well as for type 2 diabetes, are among the most commonly performed gastrointestinal operations today, justifying periodic assessment of the numerical status of metabolic/bariatric surgery and its relative distribution of procedures.

Methods

An email questionnaire was sent to the leadership of the 50 nations or national groupings in the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). Outcome measurements were numbers of metabolic/bariatric operations and surgeons, types of procedures performed, and trends from 2003 to 2008 to 2011 worldwide and in the regional groupings of Europe, USA/Canada, Latin/South America, and Asia/Pacific.

Results

Response rate was 84 %. The global total number of procedures in 2011 was 340,768; the global total number of metabolic/bariatric surgeons was 6,705. The most commonly performed procedures were Roux-en-Y gastric bypass (RYGB) 46.6 %; sleeve gastrectomy (SG) 27.8 %; adjustable gastric banding (AGB) 17.8 %; and biliopancreatic diversion/duodenal switch (BPD/DS) 2.2 %. The global trends from 2003 to 2008 to 2011 showed a decrease in RYGB: 65.1 to 49.0 to 46.6 %; an increase, followed by a steep decline, in AGB: 24.4 to 42.3 to 17.8 %; and a marked increase in SG: 0.0 to 5.3 to 27.89 %. BPD/DS declined: 6.1 to 4.9 to 2.1 %. The trends from the four IFSO regions differed, except for the universal increase in SG.

Conclusions

Periodic metabolic/bariatric surgery surveys add to the knowledge and understanding of all physicians caring for morbidly obese patients. The salient message of the 2011 assessment is that SG (0.0 % in 2008) has markedly increased in prevalence.

Keywords

Metabolic/bariatric surgery Morbid obesity Type 2 diabetes IFSO Survey Worldwide trends 

Introduction

The most efficacious therapy for morbid obesity today is metabolic/bariatric surgery, an approach that has now been recommended for management of type 2 diabetes in certain obese patients [1]. These operations are among the most commonly performed gastrointestinal procedure in operating rooms today. The types of metabolic/bariatric operations are in continuous flux. For these reasons, a periodic assessment of the state of metabolic/bariatric surgery is useful in understanding its role and its scope as a treatment modality. The information gained is important to, and may well guide, the decision making of metabolic/bariatric surgeons and their patients, as well as be a source of knowledge to physicians in general, the public, healthcare providers, and governments. These data will also be found pertinent by scientists in the fields of obesity and the metabolic syndrome.

In 1998, Dr. Scopinaro published the first worldwide survey of metabolic/bariatric surgery [2]. In 2004 [3] and again in 2009 [4], we published follow-up reports for 2003 and 2009, respectively. The current interval assessment analyzes the number of operations, the numbers of surgeons, and the distribution of procedures being performed in the nations or national groupings of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) in 2011.

Methods

Survey

An email questionnaire (Table 1) was sent to the leadership of the 50 nations or national groupings in IFSO. If no response was received, second and third email requests were made, often followed by telephone calls, as well as contacting regional IFSO members to request their aid in soliciting a response.
Table 1

Questionnaire

Data Analysis

Tables and graphic presentations were compiled for the obtained and derived data. The relative prevalences of specific procedures are provided as weighted averages to account for the wide ranges in the number of procedures performed by the different IFSO member nations or national groupings.

Results

Response Rate

From the 50 nations or national groupings of IFSO canvassed, there were 42 responders (84 %). Responders are listed in Table 2. Australia and New Zealand, and the USA and Canada were national groupings. Nonresponders were Bolivia, Costa Rica, Panama, Paraguay, Peru, Philippines, Serbia, and Venezuela.
Table 2

Number of responders, operations performed, metabolic/bariatric surgeons, and specific metabolic/bariatric surgery procedure in each responding nation or national grouping

Nations

AGB

SG

RYGB

LL-RYGB

Mini-GB

BPD

DS

VBG

Elect. pacers

others

Total cases

Number of surgeons

Argentina

990

2,200

1,705

110

0

220

110

0

0

165

5,500

120

Australia/New Zealand

7,200

4,200

360

0

0

0

0

0

0

240

12,000

150

Austria

221

375

1,310

39

68

26

0

0

5

37

2,081

55

Belgium

680

1,105

6,205

170

170

0

170

0

0

0

8,500

150

Brazil

1,950

13,000

45,500

325

0

650

3,250

0

0

325

65,000

2,750

Chile

0

3916

1393

0

0

0

0

0

0

245

5,554

54

Colombia

0

3,360

3,430

0

70

35

35

0

0

70

7,000

150

Czech Republic

465

465

8

0

7

60

0

0

0

495

1,500

10

Ecuador

15

90

45

0

0

0

0

0

0

0

150

12

Egypt

530

896

620

0

38

0

0

826

0

0

2,910

31

Finland

2

134

918

1

0

0

1

0

0

0

1,056

32

France

6,574

10,781

5,307

0

3,234

131

55

967

0

599

27,648

310

Germany

240

1,600

1,980

0

40

4

0

0

12

124

4,000

60

Greece

403

651

249

185

0

23

0

8

0

31

1,550

35

Guatemala

108

36

36

0

0

0

0

0

0

0

180

3

Hungary

209

4

14

0

0

0

0

0

0

0

227

4

Iceland

21

2

83

0

0

0

0

0

0

0

106

2

India

50

4,000

750

50

50

0

50

0

0

50

5,000

100

Israel

1,000

3,000

1,000

0

0

0

0

0

0

0

5,000

50

Italy

2,632

2,202

1,795

0

0

426

21

70

0

90

7,236

272

Japan

7

94

23

0

0

1

45

0

0

0

170

19

Kuwait

200

3,905

488

13

3

2

2

3

10

0

4,626

55

Lithuania

102

3

140

0

0

0

1

0

0

2

248

6

Mexico

2,355

8,347

6,656

459

153

0

76

153

0

1,401

19,600

200

Netherlands

1,000

750

3,050

0

50

100

50

0

0

0

5,000

30

Poland

256

516

370

11

65

5

3

10

0

14

1,250

38

Portugal

684

633

1590

6

12

15

12

3

0

73

3,028

60

Romania

63

563

59

0

0

2

0

84

0

157

928

25

Russia

415

368

37

141

0

9

99

7

0

24

1,100

70

Saudi Arabia

700

3500

2100

0

280

350

0

70

0

0

7,000

48

Singapore

50

97

50

0

1

2

0

0

0

0

200

16

Slovenia

30

15

93

0

0

0

0

9

0

3

150

4

S Africa

10

10

920

6

0

6

48

0

0

0

1,000

12

Spain

110

1,390

4,539

0

921

202

377

0

0

311

7,850

259

Sweden

29

42

8,177

0

0

1

69

0

0

182

8,500

Depts-44

Switzerland

121

234

1,991

0

0

8

5

0

0

207

2,566

Hosp-5

Taiwan

78

541

495

0

56

2

14

0

0

114

1,300

20

Turkey

135

63

51

21

9

18

2

2

0

0

301

22

Ukraine

59

15

13

0

0

4

8

0

0

46

145

35

UK

3,060

840

5,038

432

0

0

20

0

0

610

10,000

120

USA/Canada

27,630

19,486

47,791

0

17

22

748

85

7

5,859

101,645

1,248

UAE

293

1260

381

0

6

0

0

0

0

23

1963

19

Total

60,677

94,689

156,760

1,969

5,250

2,324

5,271

2,297

34

11,497

340,768

6,705

AGB adjustable gastric band, SG sleeve gastrectomy, RYGB Roux-en-Y gastric bypass, LL-RYGB long-limb Roux-en-Y gastric bypass, Mini-GB mini gastric bypass, BPD biliopancreatic diversion, DS duodenal switch, VBG vertical banded gastroplasty

Number of Operations Performed

The number of operations performed in each responding nation or national grouping is presented in Table 2, as well as the total for all responders. The global total in 2011 was 340,768. USA/Canada performed the largest number of operations (101,645), followed by Brazil (65,000), France (27,648), Mexico (19,000), Australia and New Zealand (12,000), and the UK (10,000). No other nation performed 10,000 or more operations.

The numbers of operations performed as a percentage of the national population are presented in Table 3. There are vast differences in this percentage, e.g., Belgium (0.7722 %), Kuwait (0.1642 %), and Sweden (0.0899 %) in contrast to India (0.0004 %), Ukraine (0.0003 %), and Japan (0.0001 %). USA/Canada was 0.0326 %. No country reached 1 %. For the total population of the 50 IFSO nations or national groupings of 3,092,387,322, there were 340,768 metabolic/bariatric operations performed in 2011, representing 0.0110 % of the total population.
Table 3

Numbers of operations performed as a percentage of the national population

Nations

Total populationa

Bariatric cases

Percentage

Argentina

40,764,561

5,500

0.0135

Australia/New Zealand

23,061,120

12,000

0.0520

Austria

8,419,000

2,081

0.0247

Belgium

1,100,800

8,500

0.7722

Brazil

196,655,014

65,000

0.0331

Chile

17269525

5,554

0.0322

Colombia

46,927,125

7,000

0.0149

Czech Republic

10,546,000

1,500

0.0142

Ecuador

14,666,055

150

0.0010

Egypt

82,536,770

2,910

0.0035

Finland

5,387,000

1,056

0.0196

France

65,436,552

27,648

0.0423

Germany

81,726,000

4,000

0.0049

Greece

11,304,000

1,550

0.0137

Guatemala

14,757,316

180

0.0012

Hungary

9,971,000

227

0.0023

Iceland

319,000

106

0.0332

India

1,241,491,960

5,000

0.0004

Israel

7,765,700

5,000

0.0644

Italy

60,626,442

7,236

0.0119

Japan

127,817,277

170

0.0001

Kuwait

2,818,042

4,626

0.1642

Lithuania

3,203,000

248

0.0077

Mexico

114,800,000

19,600

0.0171

Netherlands

16,696,000

5,000

0.0299

Poland

38,216,000

1,250

0.0033

Portugal

10637000

3,028

0.0285

Romania

21,390,000

928

0.0043

Russia

141,930,000

1,100

0.0008

Saudi Arabia

28,082,541

7,000

0.0249

Singapore

5,183,700

200

0.0039

Slovenia

2,052,000

150

0.0073

S Africa

50,586,757

1,000

0.0020

Spain

46,240,000

7,850

0.0170

Sweden

9,453,000

8,500

0.0899

Switzerland

7,907,000

2,566

0.0325

Taiwan

23,174,528

1,300

0.0056

Turkey

73,639,596

301

0.0004

Ukraine

45,706,100

145

0.0003

UK

62,641,000

10,000

0.0160

USA/Canada

311,591,917

101,645

0.0326

UAE

7,890,924

1,963

0.0249

Total

3,092,387,322

340,768

0.0110

a2011 data from the World Bank (www.data.worldbank.org/country)

Number of Metabolic/Bariatric Surgeons

The number of metabolic/bariatric surgeons in each responding nation or national grouping is presented in Table 2, as well as the total for all responders. For Sweden, the number provided (44) represented the number of surgery departments; the number for Switzerland is for the number of hospitals (five) engaged in metabolic/bariatric surgery. The global total in 2011 was 6,705. Brazil had the largest number (2,750), followed by USA/Canada (1,248), the only other country with more than 1,000 metabolic/bariatric surgeons.

The numbers of metabolic/bariatric surgeons as a percentage of the national population are presented in Table 4. There are vast differences in this percentage, e.g., Belgium (0.01363 %), Kuwait (0.00195 %), and Brazil (0.00140 %) in contrast to Guatemala and South Africa (0.00002 % each), and India and Japan (0.00001 % each). USA/Canada was 0.00040 %. For the total population of the 50 nations or national groupings of 3,092,387,322, there were 6,815 metabolic/bariatric surgeons in 2011, representing 0.00022 % of the total population.
Table 4

Numbers of metabolic/bariatric surgeons as a percentage of the national population

Nations

Total populationa

Bariatric surgeons

Percentage

Argentina

40,764,561

120

0.00029

Australia/New Zealand

23,061,120

150

0.00065

Austria

8,419,000

55

0.00065

Belgium

1,100,800

150

0.01363

Brazil

196,655,014

2,750

0.00140

Chile

17269525

54

0.00031

Colombia

46,927,125

150

0.00032

Czech Republic

10,546,000

10

0.00009

Ecuador

14,666,055

122

0.00083

Egypt

82,536,770

31

0.00004

Finland

5,387,000

32

0.00059

France

65,436,552

310

0.00047

Germany

81,726,000

60

0.00007

Greece

11,304,000

35

0.00031

Guatemala

14,757,316

3

0.00002

Hungary

9,971,000

4

0.00004

Iceland

319,000

2

0.00063

India

1,241,491,960

100

0.00001

Israel

7,765,700

50

0.00064

Italy

60,626,442

272

0.00045

Japan

127,817,277

19

0.00001

Kuwait

2,818,042

55

0.00195

Lithuania

3,203,000

6

0.00019

Mexico

114,800,000

200

0.00017

Netherlands

16,696,000

30

0.00018

Poland

38,216,000

38

0.00010

Portugal

10637000

60

0.00056

Romania

21,390,000

25

0.00012

Russia

141,930,000

70

0.00005

Saudi Arabia

28,082,541

48

0.00017

Singapore

5,183,700

16

0.00031

Slovenia

2,052,000

4

0.00019

S Africa

50,586,757

12

0.00002

Spain

46,240,000

259

0.00056

Sweden

9,453,000

44

0.00047

Switzerland

7,907,000

5

0.00006

Taiwan

23,174,528

20

0.00009

Turkey

73,639,596

22

0.00003

Ukraine

45,706,100

35

0.00008

UK

62,641,000

120

0.00019

USA/Canada

311,591,917

1,248

0.00040

UAE

7,890,924

19

0.00024

Total

3,092,387,322

6,815

0.00022

a2011 data from the World Bank (www.data.worldbank.org/country)

Types of Procedures Performed

The number of a specific metabolic/bariatric surgery procedure for each responder nation or national grouping is provided in Table 2, as well as the total for all responders. Open and laparoscopic procedures were combined. The percentage distributions of metabolic/bariatric operations, using weighted averages, are given in Table 5. The most commonly performed procedure was Roux-en-Y gastric bypass (RYGB), 46.6 %, followed by sleeve gastrectomy (SG), 27.8 %, and adjustable gastric banding (AGB), 17.8 %. No other single procedure exceeded 2.5 %.
Table 5

Percentage distribution of metabolic bariatric procedures worldwide

Procedure

Number

Percentage

Roux-en-Y gastric bypass

158,729

46.6

Sleeve gastrectomy

94,689

27.8

Adjustable gastric band

60,677

17.8

Biliopancreatic diversion/ duodenal switch

7,595

2.2

Mini gastric bypass

5,250

1.5

Vertical banded gastroplasty

2,297

0.7

Electric pacers

34

0.01

Others and revisions

11,497

3.4

Total procedures: 340,768

Trends

Trend analyses from 2003 to 2008 to 2011 are based on the current results and previously published data [3, 4].

Worldwide

The trends in the number and percentage of RYGB, AGB, SG, and biliopancreatic diversion/duodenal switch (BPD/DS) from 2003 to 2008 to 2011 worldwide are presented in Figs. 1 and 2. RYGB decreased from 2003 (65.1 %) to 2008 (49.0 %) and remained fairly constant to 2011 (46.6 %). AGB peaked in 2008 (42.3 %) and then in 2011 fell to 17.8 %, which is below the 2003 value of 24.4 %. SG showed a marked rise over the three time intervals: 0 to 5.3 to 27.8 %. There was a decrease in BPD/DS: 4.8 to 2.0 to 2.2 %.
Fig. 1

Trends in the numbers of procedures worldwide: 2003 to 2008 to 2011

Fig. 2

Trends in percentage of procedures worldwide: 2003 to 2008 to 2011

Regional

Europe

The regional trend in Europe in the number of procedures is given in Table 6 and in the percentage of procedures in Fig. 3. There was a precipitous decrease over the 8-year time span in the AGB, the percentage of procedures falling from 63.7 to 17.8 %, intersecting the rise in the SG from 0.0 to 27.8 %. The RYGB dramatically rose from 11.1 to 39.0 % between 2003 and 2005 and then less strongly to 43.5 % in 2011.
Table 6

Regional trends in Europe

 

Operations (%) 2003

Operations (%) 2008

Operations (%) 2011

2008 to 2011 change (%)

Total

33,771

66,769

112,843

+69.0

RYGB

3,744 (11.1)

26,023 (39.0)

49,050 (43.5)

+88.5

AGB

21,496 (63.7)

28,843 (43.2)

20,044 (17.8)

−30.5

BPD/DS

2,061 (6.1)

3,270 (4.9)

2,331 (2.1)

−28.7

SG

0 (0.0)

4,677 (7.0)

31,418 (27.8)

+571.8

RYGB Roux-en-Y gastric bypass, AGB adjustable gastric banding, BPD/DS biliopancreatic diversion/duodenal switch, SG sleeve gastrectomy

Fig. 3

Trends in percentage of procedures Europe: 2003 to 2008 to 2011

USA/Canada

The regional trend in USA/Canada in the number of procedures is given in Table 7 and in the percentage of procedures in Fig. 4. There was a marked decrease in RYGB from 2003 (85.0 %) to 2008 (51.0 %), with a plateauing in 2001 (47.0 %). Over these three time intervals, AGB rose from 9.0 to 44.0 % and then fell to 27.2 %. Comparable to Europe, the percentage of SG procedures steadily rose: 0.0 to 4.0 to 19.2 %.
Table 7

Regional trends in USA/Canada

 

Operations (%) 2003

Operations (%) 2008

Operations (%) 2011

2008 to 2011 change (%)

Total

103,000

220,000

101,645

−53.8

RYGB

87,550 (85.0)

112,200 (51.0)

47,791 (47.0)

−57.4

AGB

9,270 (9.0)

96,800 (44.0)

27,630 (27.2)

−71.5

BPD/DS

4,635 (4.5)

2,200 (1.0)

770 (0.8)

−65.0

SG

0 (0.0)

8,800 (4.0)

19,486 (19.2)

+121.4

RYGB Roux-en-Y gastric bypass, AGB adjustable gastric banding, BPD/DS biliopancreatic diversion/duodenal switch, SG sleeve gastrectomy

Fig. 4

Trends in percentage of procedures USA/Canada: 2003 to 2008 to 2011

Latin/South America

The regional trend in Latin/South America in the number of procedures is given in Table 8 and in the percentage of procedures in Fig. 5. AGB fell from 61.5 % in 2003 to 20.4 % in 2008 and as low as 5.3 % in 2011. Concurrently, RYGB rose and, more or less, plateaued: 20.2, 65.9, and 57.9 %. SG climbed from 0.0 to 9.2 to 30.1 %.
Table 8

Regional trends—Latin/South America

 

Operations (%) 2003

Operations (%) 2008

Operations (%) 2011

2008 to 2011 change (%)

Total

2,700

44,242

102,984

+54.2

RYGB

545 (20.2)

29,176 (65.9)

59,659 (57.9)

+129.3

AGB

1,660 (61.5)

9,028 (20.4)

5,418 (5.3)

−81.2

BPD/DS

58 (2.2)

1,370 (3.1)

4,376 (4.3)

+33.8

SG

0 (0)

4,076 (9.2)

30,949 (30.1)

+561.7

RYGB Roux-en-Y gastric bypass, AGB adjustable gastric banding; BPD/DS biliopancreatic diversion/duodenal switch, SG sleeve gastrectomy

Fig. 5

Trends in percentage of procedures Latin/South America: 2003 to 2008 to 2011

Asia/Pacific

The regional trend in the Asia/Pacific Region in the number of procedures is given in Table 9 and in the percentage of procedures in Fig. 6. AGB held steady from 2003 (80.4 %) to 2008 (82.5 %) and then fell in 2011 (32.6 %). SG had a mirror image trend to that found in the three other regions: 0.0 to 4.1 to 55.1 %. RYGB and BPD/DS never rose to over 10 % prevalence in the Asia/Pacific region.
Table 9

Regional trends in Asia/Pacific

 

Operations (%) 2003

Operations (%) 2008

Operations (%) 2011

2008 to 2011 change (%)

Total

2,770

13,210

23,296

+76.4

RYGB

234 (8.4)

1,198 (9.1)

2,229 (9.57)

+86.1

AGB

2,228 (80.4)

10,892 (82.5)

7,585 (32.6)

−30.4

BPD/DS

83 (3.0)

5 (0.04)

118 (0.51)

+2260.0

SG

0 (0.0)

545 (4.1)

12,837 (55.1)

+2255.4

RYGB Roux-en-Y gastric bypass, AGB adjustable gastric banding; BPD/DS biliopancreatic diversion/duodenal switch, SG sleeve gastrectomy

Fig. 6

Trends in percentage of procedures Asia/Pacific: 2003 to 2008 to 2011

Discussion

This survey indicates that there has been no significant change in the number of bariatric procedures over the past 3 years, with a plateauing of about 340,000 performed in 42 of the 50 IFSO nations or national groupings in 2011. During this time interval, the number of bariatric surgeons, including surgical groups and hospitals engaged in bariatric surgery, has increased within the countries represented in the survey. Within the total number of procedures performed, there have been marked shifts in the relative percentages of the specific bariatric operations being done. Worldwide trends over the past 8 years showed a steep decrease in AGB with a concomitant steep increase in SG, with RYGB increasing slightly overall. This pattern is repeated with respect to AGB and SG in the four regions of IFSO–Europe, USA/Canada, Latin/South American, and Asia/Pacific. For RYGB, Europe increased, USA/Canada markedly decreased, Latin/South America markedly increased, and Asia/Pacific stayed constant and extremely low.

Certain hypotheses, or rather speculations, can be drawn from the shifting percentages of the type of procedure being performed. Over time, a given operation’s weight-loss efficacy decreases and long-term complications increase. This predictable evolution could explain the drop in AGB in Europe, with the longest history of AGB in the world, and the decrease in RYGB in the USA/Canada grouping, with the longest history of RYGB in the world. With the overall number of operations essentially constant, a reduction in the number of a given operation must be balanced by an increase in the number of another. Worldwide, this increase has occurred in the number of SG performed, which rose from 0.0 % 8 years ago to over 25 % today. Another factor in the global popularity of SG may be faddism; surgeons and patients are not exempt from gravitating toward the latest innovation, even in their choice of a surgical operation.

A reason rarely discussed in the choice of operations is the skill of the surgeon. The numbers of BPD/DS remain extremely low (<3 %) worldwide, even though this procedure has the best statistics for excess weight loss, lasting effect, and reversal of comorbidities [5]. BPD/DS procedures are difficult to perform, possibly causing less experienced bariatric surgeons to avoid offering this operation to their patients. Further, BPD/DS are time-consuming, and, in a climate of emphasis on speed, performing these procedures decreases the number of operations a surgeon can complete in a day and, thereby, the income the surgeon can derive.

There are two distinct outliers in this survey. They are the populous countries of the USA/Canada and Brazil, the leading nations over the past 8 years in bariatric surgery activity. Over these past 3 years, USA/Canada has reported 54 % fewer operations (220,000 to 101,645) and 23 % fewer bariatric surgeons (1,625 to 1,248). On inquiry, the American Society for Metabolic and Bariatric Surgery (ASMBS), the provider of the USA/Canada data, stated that they have changed their methods of accounting and that the 2008 numbers were probably artificially inflated [ASMBS, personal communication]. Brazil had an increase in the number of operations of 62 % (25,000 to 65,000) and in the number of bariatric surgeons of 295 % (700 to 2,750). The Brazilian reporting sources for 2008 were different from the sources for 2011.

This survey is a systematic attempt to provide and correlate global bariatric surgery data. The estimates given of numbers and trends are the best available today. The weaknesses of this survey are that not all nations performing bariatric surgery belong to IFSO and were, therefore, canvassed; the response rate from IFSO nations and national groupings was not 100 but 84 % (42 out of 50). The numbers provided were the best estimates, and the estimation methods and the estimators, particularly in certain countries, have changed over the years.

The World Health Organization calculates that there are 500 million obese people in the world, representing 10 % of the population [6]. The Centers for Disease Control of the USA state that more than one-third of adults in the USA are obese (excess body weight >30 kg/m2) [7]. Though metabolic/bariatric surgery plays a major role in the management of the morbidly obese today, it, obviously, cannot be relied upon to manage the global obesity epidemic. Considering the current estimates of prevalence, it is highly unlikely that metabolic/bariatric procedures will ever be utilized to treat more than 1 % of obese individuals. Metabolic/bariatric surgery, however, provides a vast clinical laboratory for studying the neurohormonal mechanisms responsible for outcomes and, by inference verifiable by investigation, the underlying abnormalities of certain metabolic diseases, e.g., type 2 diabetes. Indeed, by understanding the metabolic basis of this discipline, it may be possible to understand and, thereby, successfully manage the world obesity epidemic without the need for metabolic/bariatric surgery.

In conclusion, metabolic/bariatric surgery surveys are helpful and should be periodically, if not annually, performed to further our knowledge on what is happening in the field, clinically and intellectually, and the direction in which it is proceeding. The salient message of metabolic/bariatric surgery worldwide 2011 is that SG is the operation to scrutinize for its future prevalence and outcomes.

Notes

Acknowledgments

We thank the following individuals and nations, or national groupings, for providing the data for this survey: Argentina, Carlos Casalnuovo; Australia, Lilian Kow; Austria, Karl Miller; Belgium, Bruno Dillemans; Brazil, Ricardo Cohen; Chile, Juan Eduardo Contreras Paraguez; Colombia, Rami Mikler; Czech Republic, Martin Fried; Ecuador, Luis Burbano; Egypt, Khaled Gawdat; Finland, Anne Juuti; France, Jean-Marc Chevallier; Germany, Christine Stroh; Greece, Harry Pappis; Guatemala, Estuardo Behrens; Hungary, Bende János; Iceland, Audun Sigurdsson; India, Mahendra Narwaria; Israel, Asnat Raziel; Italy, Nicola Basso; Japan, Kazunori Kasama; Kuwait, Mohammad Aljarallah; Lithuania, Brimas Gintautas; Mexico, Juan Antonio Lopez Corvala; Poland, Mariusz Wylezol; Portugal, Mário Neves; Romania, Nicolae Iordache; Russia, Yury Yashkov; Saudi Arabia, Sultan Al Temyatt; Singapore, Anton Cheng; Slovenia, Tadeja Pintar; South Africa, Tess van der Merwe; Spain, Aniceto Baltasar; Sweden, Ingmar Näslund; Switzerland, Michel Suter; Taiwan, Wei-Jei Lee; The Netherlands, René Klaassen; Turkey, Mustafa Taskin; Ukraine, Andriy Lavryk; United Arab Emirate, Fawaz Torab; UK, Richard Welbourn; USA–Canada, Ranjan Sudan, Jaime Ponce, Clifford Ko, and John Morton. This study was supported by Baxter Healthcare Corporation, Deerfield, IL

Conflict of Interest

Henry Buchwald, MD, PhD received honoraria for manuscript preparation from Baxter Healthcare Corporation, Deerfield, IL. Danette M. Oien has none to declare.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of MinnesotaMinneapolisUSA

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