Metabolic and Bariatric Surgery - a Review of Available Surgical Procedures
DOI:
https://doi.org/10.12775/QS.2026.53.68440Keywords
BMI, bariatric surgery, obesity, sleeve gastrectomy, Roux-en-Y gastric bypassAbstract
Introduction: The aim of this review is to provide an overview of currently available bariatric and metabolic surgical procedures. Obesity has become a global health problem, significantly increasing the risk of cardiovascular disease, type 2 diabetes, malignancies, and other chronic conditions. In patients with severe obesity, conservative treatment often fails to achieve sustained weight loss. Bariatric surgery represents the most effective therapeutic option, offering durable weight reduction and improvement of obesity-related comorbidities. Currently, sleeve gastrectomy and Roux-en-Y gastric bypass are the most commonly performed procedures, while other established and emerging techniques differ in efficacy, risk profile, and level of supporting evidence.
Aim: The purpose of this review is to present a comprehensive overview of metabolic and bariatric surgical methods used in the treatment of obesity. It outlines patient qualification criteria and reviews both established procedures with proven long-term efficacy and newer surgical and endoscopic techniques with limited follow-up data.
Materials and methods: A comprehensive review of the literature was conducted using the PubMed and Google Scholar databases using keywords: “obesity”, “bariatric surgery”, “weight loss surgery”, metabolic and bariatric surgery”, “obesity treatment”. References cited in the included articles were also screened to identify additional relevant sources.
Conclusion: Bariatric and metabolic surgery remains a key component in the management of severe obesity. Given the diversity of available procedures, surgical strategy should be individualized based on patient characteristics and treatment goals. Further long-term studies are needed to better define the role of newer techniques and optimize outcomes in bariatric surgery.
References
1. Fried M, Yumuk V, Oppert JM, et al. Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery. Obes Surg. 2014;24(1):42-55. https://doi:10.1007/s11695-013-1079-8
2. Kelly T, Yang W, Chen C-S, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes. 2008;32(9):1431-1437. https://doi:10.1038/ijo.2008.102
3. Gossmann M, Butsch WS, Jastreboff AM. Treating the Chronic Disease of Obesity. Med Clin North Am. 2021;105(6):983-1016. https://doi:10.1016/j.mcna.2021.06.005
4. Kawai T, Autieri M V., Scalia R. Adipose tissue inflammation and metabolic dysfunction in obesity. Am J Physiol Physiol. 2021;320(3):C375-C391. https://doi:10.1152/ajpcell.00379.2020
5. Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444(7121):860-867. https://doi:10.1038/nature05485
6. Kinlen D, Cody D, O’Shea D. Complications of obesity. QJM An Int J Med. 2018;111(7):437-443. https://doi:10.1093/qjmed/hcx152
7. Frühbeck G, Toplak H, Woodward E, et al. Obesity: the gateway to ill health - an EASO position statement on a rising public health, clinical and scientific challenge in Europe. Obes Facts. 2013;6(2):117-120. https://doi:10.1159/000350627
8. Salmón-Gómez L, Catalán V, Frühbeck G, Gómez-Ambrosi J. Relevance of body composition in phenotyping the obesities. Rev Endocr Metab Disord. 2023;24(5):809-823. https://doi:10.1007/s11154-023-09796-3
9. Cheng J, Gao J, Shuai X, Wang G, Tao K. The comprehensive summary of surgical versus non-surgical treatment for obesity: a systematic review and meta-analysis of randomized controlled trials. Oncotarget. 2016;7(26):39216-39230. https://doi:10.18632/oncotarget.9581
10. Hsu JL, Farrell TM. Updates in Bariatric Surgery. Am Surg. 2024;90(5):925-933. https://doi:10.1177/00031348231220576
11. NIH conference. Gastrointestinal surgery for severe obesity. Consensus Development Conference Panel. Ann Intern Med. 1991;115(12):956-961. http://www.ncbi.nlm.nih.gov/pubmed/1952493
12. Saltzman E, Anderson W, Apovian CM, et al. Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient. Obes Res. 2005;13(2):234-243. https://doi:10.1038/oby.2005.32
13. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis. 2022;18(12):1345-1356. https://doi:10.1016/j.soard.2022.08.013
14. Angrisani L, Santonicola A, Iovino P, Formisano G, Buchwald H, Scopinaro N. Bariatric Surgery Worldwide 2013. Obes Surg. 2015;25(10):1822-1832. https://doi:10.1007/s11695-015-1657-z
15. Aminian A, Vosburg RW, Altieri MS, Hinojosa MW, Khorgami Z. The American Society for Metabolic and Bariatric Surgery (ASMBS) updated position statement on perioperative venous thromboembolism prophylaxis in bariatric surgery. Surg Obes Relat Dis. 2022;18(2):165-174. https://doi:10.1016/j.soard.2021.10.023
16. Medical Advisory Secretariat. Bariatric surgery: an evidence-based analysis. Ont Health Technol Assess Ser. 2005;5(1):1-148. http://www.ncbi.nlm.nih.gov/pubmed/23074460
17. Steenackers N, Vanuytsel T, Augustijns P, et al. Adaptations in gastrointestinal physiology after sleeve gastrectomy and Roux-en-Y gastric bypass. Lancet Gastroenterol Hepatol. 2021;6(3):225-237. https://doi:10.1016/S2468-1253(20)30302-2
18. Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery. Obes Surg. 2023;33(1):3-14. https://doi:10.1007/s11695-022-06332-1
19. Phillips BT, Shikora SA. The history of metabolic and bariatric surgery: Development of standards for patient safety and efficacy. Metabolism. 2018;79:97-107. https://doi:10.1016/j.metabol.2017.12.010
20. Lainas P, Derienne J, Dammaro C, Schoucair N, Devaquet N, Dagher I. Single-port Laparoscopic Surgery for the Treatment of Severe Obesity: Review and Perspectives. Obes Surg. 2020;30(7):2781-2790. https://doi:10.1007/s11695-020-04620-2
21. Climaco K, Ahnfeldt E. Laparoscopic Vertical Sleeve Gastrectomy. Surg Clin North Am. 2021;101(2):177-188. https://doi:10.1016/j.suc.2020.12.015
22. Kissane NA, Pratt JSA. Medical and surgical treatment of obesity. Best Pract Res Clin Anaesthesiol. 2011;25(1):11-25. https://doi:10.1016/j.bpa.2011.01.001
23. Benaiges D. Laparoscopic sleeve gastrectomy: More than a restrictive bariatric surgery procedure? World J Gastroenterol. 2015;21(41):11804. https://doi:10.3748/wjg.v21.i41.11804
24. Brethauer SA. Sleeve Gastrectomy. Surg Clin North Am. 2011;91(6):1265-1279. https://doi:10.1016/j.suc.2011.08.012
25. Chung AY, Thompson R, Overby DW, Duke MC, Farrell TM. Sleeve Gastrectomy: Surgical Tips. J Laparoendosc Adv Surg Tech. 2018;28(8):930-937. https://doi:10.1089/lap.2018.0392
26. Mason EE, Ito C. Gastric Bypass in Obesity. Surg Clin North Am. 1967;47(6):1345-1351. https://doi:10.1016/S0039-6109(16)38384-0
27. Baker MT. The History and Evolution of Bariatric Surgical Procedures. Surg Clin North Am. 2011;91(6):1181-1201. https://doi:10.1016/j.suc.2011.08.002
28. GRIFFEN WO, YOUNG VL, STEVENSON CC. A Prospective Comparison of Gastric and Jejunoileal Bypass Procedures for Morbid Obesity. Ann Surg. 1977;186(4):500-509. https://doi:10.1097/00000658-197710000-00012
29. Nudel J, Sanchez VM. Surgical management of obesity. Metabolism. 2019;92:206-216. https://doi:10.1016/j.metabol.2018.12.002
30. Colquitt JL, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane database Syst Rev. 2014;2014(8):CD003641. https://doi:10.1002/14651858.CD003641.pub4
31. Sridhar A, Khan D, Elliott JA, et al. RYGB surgery has modest effects on intestinal morphology and gut hormone populations in the bypassed biliopancreatic limb but causes reciprocal changes in GLP-2 and PYY in the alimentary limb. PLoS One. 2023;18(5):e0286062. https://doi:10.1371/journal.pone.0286062
32. van Beek AP, Emous M, Laville M, Tack J. Dumping syndrome after esophageal, gastric or bariatric surgery: pathophysiology, diagnosis, and management. Obes Rev. 2017;18(1):68-85. https://doi:10.1111/obr.12467
33. Beitner M, Kurian MS. Laparoscopic adjustable gastric banding. Abdom Radiol. 2012;37(5):687-689. https://doi:10.1007/s00261-012-9864-8
34. Jaunoo SS, Southall PJ. Bariatric surgery. Int J Surg. 2010;8(2):86-89. https://doi:10.1016/j.ijsu.2009.12.003
35. Marceau P, Biron S, Bourque R-A, Potvin M, Hould F-S, Simard S. Biliopancreatic Diversion with a New Type of Gastrectomy. Obes Surg. 1993;3(1):29-35. https://doi:10.1381/096089293765559728
36. Requarth JA. Long-term Morbidity Following Jejunoileal Bypass. Arch Surg. 1995;130(3):318. https://doi:10.1001/archsurg.1995.01430030088018
37. Singh D, Laya AS, Clarkston WK, Allen MJ. Jejunoileal bypass: A surgery of the past and a review of its complications. World J Gastroenterol. 2009;15(18):2277. https://doi:10.3748/wjg.15.2277
38. Sudan R, Jacobs DO. Biliopancreatic Diversion with Duodenal Switch. Surg Clin North Am. 2011;91(6):1281-1293. https://doi:10.1016/j.suc.2011.08.015
39. Albaugh VL, Abumrad NN. Surgical treatment of obesity. F1000Research. 2018;7. https://doi:10.12688/f1000research.13515.1
40. Risstad H, Søvik TT, Engström M, et al. Five-Year Outcomes After Laparoscopic Gastric Bypass and Laparoscopic Duodenal Switch in Patients With Body Mass Index of 50 to 60. JAMA Surg. 2015;150(4):352. https://doi:10.1001/jamasurg.2014.3579
41. Rutledge R, Kular K, Manchanda N. The Mini-Gastric Bypass original technique. Int J Surg. 2019;61:38-41. https://doi:10.1016/j.ijsu.2018.10.042
42. Musella M, Chiappetta S, Franzese A, et al. OAGB 2025. A systematic review with meta-analysis of indications and results for primary procedures at 5+ years. Updates Surg. 2025;77(7):2059-2076. https://doi:10.1007/s13304-025-02420-w
43. Ortíz-Gómez JE, González-Barajas AI, Guevara-Díaz JA, Mancilla-Galindo J, Kammar-García A, Guerrero-Gutierrez MA. One anastomosis gastric bypass (OAGB): a scoping review. BMC Surg. 2025;25(1):471. https://doi:10.1186/s12893-025-03215-x
44. Rutledge R. The Mini-Gastric Bypass: Experience with the First 1,274 Cases. Obes Surg. 2001;11(3):276-280. https://doi:10.1381/096089201321336584
45. Wang F-G, Yan W-M, Yan M, Song M-M. Outcomes of Mini vs Roux-en-Y gastric bypass: A meta-analysis and systematic review. Int J Surg. 2018;56:7-14. https://doi:10.1016/j.ijsu.2018.05.009
46. Balamurugan G, Leo SJ, Sivagnanam ST, et al. Comparison of Efficacy and Safety Between Roux-en-Y Gastric Bypass (RYGB) vs One Anastomosis Gastric Bypass (OAGB) vs Single Anastomosis Duodeno-ileal Bypass with Sleeve Gastrectomy (SADI-S): a Systematic Review of Bariatric and Metabolic Surgery. Obes Surg. 2023;33(7):2194-2209. https://doi:10.1007/s11695-023-06602-6
47. De Luca M, Zese M, Bandini G, et al. Metabolic bariatric surgery as a therapeutic option for patients with type 2 diabetes: A meta‐analysis and network meta‐analysis of randomized controlled trials. Diabetes, Obes Metab. 2023;25(8):2362-2373. https://doi:10.1111/dom.15117
48. Kermansaravi M, Chiappetta S, Kassir R, et al. Efficacy of One Anastomosis Gastric Bypass Versus Sleeve Gastrectomy and Roux-en-Y Gastric Bypass for the Treatment of Type 2 Diabetes Mellitus: a Systematic Review and Meta-Analysis of Randomized Clinical Trials. Obes Surg. 2024;34(12):4555-4562. https://doi:10.1007/s11695-024-07564-z
49. Meyer HHG, Riauka R, Dambrauskas Z, Mickevicius A. The effect of surgical gastric plication on obesity and diabetes mellitus type 2: a systematic review and meta-analysis. Wideochirurgia i inne Tech maloinwazyjne = Videosurgery other miniinvasive Tech. 2021;16(1):10-18. https://doi:10.5114/wiitm.2020.97424
50. Talebpour M, Amoli BS. Laparoscopic Total Gastric Vertical Plication in Morbid Obesity. J Laparoendosc Adv Surg Tech. 2007;17(6):793-798. https://doi:10.1089/lap.2006.0128
51. Fried M, Dolezalova K, Buchwald JN, McGlennon TW, Sramkova P, Ribaric G. Laparoscopic Greater Curvature Plication (LGCP) for Treatment of Morbid Obesity in a Series of 244 Patients. Obes Surg. 2012;22(8):1298-1307. https://doi:10.1007/s11695-012-0684-2
52. Park J-H, Kim S-M. High-rate of long-term revision surgery due to weight regain after Laparoscopic Gastric Greater Curvature Plication (LGGCP). Asian J Surg. 2023;46(2):850-855. https://doi:10.1016/j.asjsur.2022.09.001
53. Gudaityte R, Adamonis K, Maleckas A. Laparoscopic Gastric Greater Curvature Plication: Intermediate Results and Factors Associated with Failure. Obes Surg. 2018;28(12):4087-4094. https://doi:10.1007/s11695-018-3465-8
54. Khidir N, Al Dhaheri M, El Ansari W, Al Kuwari M, Sargsyan D, Bashah M. Outcomes of Laparoscopic Gastric Greater Curvature Plication in Morbidly Obese Patients. J Obes. 2017;2017:7989714. https://doi:10.1155/2017/7989714
55. Sánchez-Pernaute A, Rubio Herrera MA, Pérez-Aguirre E, et al. Proximal Duodenal–Ileal End-to-Side Bypass with Sleeve Gastrectomy: Proposed Technique. Obes Surg. 2007;17(12):1614-1618. https://doi:10.1007/s11695-007-9287-8
56. Sánchez-Pernaute A, Rubio MÁ, Cabrerizo L, Ramos-Levi A, Pérez-Aguirre E, Torres A. Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) for obese diabetic patients. Surg Obes Relat Dis. 2015;11(5):1092-1098. https://doi:10.1016/j.soard.2015.01.024
57. Sánchez-Pernaute A, Herrera MAR, Pérez-Aguirre ME, et al. Single Anastomosis Duodeno–Ileal Bypass with Sleeve Gastrectomy (SADI-S). One to Three-Year Follow-up. Obes Surg. 2010;20(12):1720-1726. https://doi:10.1007/s11695-010-0247-3
58. Spinos D, Skarentzos K, Esagian SM, Seymour KA, Economopoulos KP. The Effectiveness of Single-Anastomosis Duodenoileal Bypass with Sleeve Gastrectomy/One Anastomosis Duodenal Switch (SADI-S/OADS): an Updated Systematic Review. Obes Surg. 2021;31(4):1790-1800. https://doi:10.1007/s11695-020-05188-7
59. Andalib A, Bouchard P, Alamri H, Bougie A, Demyttenaere S, Court O. Single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S): short-term outcomes from a prospective cohort study. Surg Obes Relat Dis. 2021;17(2):414-424. https://doi:10.1016/j.soard.2020.09.015
60. Kota S, Ugale S, Gupta N, Naik V, Kumar KVSH, Modi K. Ileal interposition with sleeve gastrectomy for treatment of type 2 diabetes mellitus. Indian J Endocrinol Metab. 2012;16(4):589. https://doi:10.4103/2230-8210.98017
61. Koopmans H, Sclafani A, Fichtner C, Aravich P. The effects of ileal transposition on food intake and body weight loss in VMH-obese rats. Am J Clin Nutr. 1982;35(2):284-293. https://doi:10.1093/ajcn/35.2.284
62. DePaula AL, Stival AR, Halpern A, Vencio S. Surgical Treatment of Morbid Obesity: Mid-term Outcomes of the Laparoscopic Ileal Interposition Associated to a Sleeve Gastrectomy in 120 Patients. Obes Surg. 2011;21(5):668-675. https://doi:10.1007/s11695-010-0232-x
63. Payab M, Hasani-Ranjbar S. Ileal interposition surgery for treatment of type 2 diabetes mellitus-pros and cons. J Diabetes Metab Disord. 2015;14(1):77. https://doi:10.1186/s40200-015-0202-x
64. Choi SJ, Choi HS. Various Intragastric Balloons Under Clinical Investigation. Clin Endosc. 2018;51(5):407-415. https://doi:10.5946/ce.2018.140
65. Francisco CPD, Ravi R, Lopez-Nava G, Asokkumar R. Endoscopic tips for intragastric balloon use for obesity: what you need to know. VideoGIE an Off video J Am Soc Gastrointest Endosc. 2024;9(10):460-462. https://doi:10.1016/j.vgie.2024.06.010
66. Bazerbachi F, Vargas EJ, Rizk M, et al. Intragastric Balloon Placement Induces Significant Metabolic and Histologic Improvement in Patients With Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol. 2021;19(1):146-154.e4. https://doi:10.1016/j.cgh.2020.04.068
67. Silva LB, Neto MG. Intragastric balloon. Minim Invasive Ther Allied Technol. 2022;31(4):505-514. https://doi:10.1080/13645706.2021.1874420
68. Shilton H. Bariatric surgery. Aust J Gen Pract. 2025;54(4):202-206. https://doi:10.31128/AJGP-10-24-7432
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Kinga Dworak, Natalia Trędota , Zuzanna Czyżewicz , Barbara Chobot , Marta Wachowska , Julia Chmielowiec , Aleksandra Chludek, Karol Dańda , Dominika Posid , Michał Lewczuk
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 118
Number of citations: 0
