Comparative Surgical Outcomes in Bariatric Surgery

Chapter

Abstract

Overwhelmingly, the evidence points to bariatric surgery as the best option to counteract the rising worldwide epidemic of obesity and related comorbidities. Increasing utilization of this resource calls for a better understanding of key available surgical choices. This review will discuss the comparative effectiveness and complications of sleeve gastrectomy (SG), Roux-en-y gastric bypass (RYGB), and biliopancreatic diversion/duodenal switch (BPD/DS). Randomized clinical trials suggest long-term weight loss, and diabetes improvement may be superior for BPD/DS compared to SG, with RYGB somewhere in the middle. Gastroesophageal reflux disease (GERD) outcomes may be superior for RYGB. Improvement in dyslipidemia and hypertension is appreciated following all three operations, and clear superiority cannot be concluded. While mortality, bleeding, leaks, and venous thromboembolism (VTE) appear to be highest after BPD/DS with lower rates for RYGB, and lowest following SG, wide variation exists regarding readmission and reoperation rates. Additional large reports derived from national or statewide prospectively maintained databases with standardized data collection and risk-adjusted reporting are needed to close the knowledge gaps in comparative outcomes for these key operations and ultimately help individualize the surgical management of obesity and related comorbidities.

Keywords

Roux-en-Y gastric bypass RYGB Sleeve gastrectomy SG Biliopancreatic diversion BPD Metabolic surgery Bariatric outcomes Bariatric complications 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Michigan Health Systems, University of MichiganAnn ArborUSA

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