Surgical Strategies for the Management of Obesity

Connie Au; Robert Brumer; Julia Schroer; Nabil Tariq

doi:10.14797/mdcvj.1513

Surgical Strategies for the Management of Obesity

Methodist DeBakey Cardiovascular Journal

Volume 21 (2025): Issue 2

By: Connie Au , Robert Brumer , Julia Schroer and Nabil Tariq

Open Access

|Feb 2025

Abstract

Obesity is one of the most difficult medical conditions to treat in the United States (US) and requires multidisciplinary treatment. Bariatric surgery is one of the most effective treatment options for morbid obesity. In this review, we describe the most up-to-date information regarding the impact of obesity on cardiovascular disease and other comorbidities as well as the various surgical approaches for treatment.

References

Van Veldhuisen SL, Gorter TM, Van Woerden G, et al. Bariatric surgery and cardiovascular disease: a systematic review and meta-analysis. Eur Heart J. 2022 May 21;43(20):1955-1969. doi: 10.1093/eurheartj/ehac071
Open DOI Search in Google Scholar Back to article
Mentias A, Aminian A, Youssef D, et al. Long-Term Cardiovascular Outcomes After Bariatric Surgery in the Medicare Population. J Am Coll Cardiol. 2022 Apr 19;79(15):1429-1437. doi: 10.1016/j.jacc.2022.01.047
Open DOI Search in Google Scholar Back to article
Clapp B, Ponce J, Corbett J, et al. American Society for Metabolic and Bariatric Surgery 2022 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2024 May;20(5):425-431. doi: 10.1016/j.soard.2024.01.012
Open DOI Search in Google Scholar Back to article
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 Jan;33(1):3-14. doi: 10.1007/s11695-022-06332-1
Open DOI Search in Google Scholar Back to article
Statpearls [Internet]. Bethesda, MD: National Library of Medicine; c2024. Seeras K, Sankararaman S, Lopez PP. Sleeve Gastrectomy; 2018 Jan 23 [cited 2024 Dec 13]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519035/
Search in Google Scholar Back to article
Chung AY, Thompson R, Overby DW, Duke MC, Farrell TM. Sleeve Gastrectomy: Surgical Tips. J Laparoendosc Adv Surg Tech A. 2018 Aug;28(8):930-937. doi: 10.1089/lap.2018.0392
Open DOI Search in Google Scholar Back to article
Hetherington A, Verhoeff K, Mocanu V, Birch DW, Karmali S, Switzer NJ. MBSAQIP risk calculator use in bariatric surgery is associated with a reduction in serious complications: a retrospective analysis of 210,710 patients. Surg Obes Relat Dis. 2023 Nov;19(11):1228-1234. doi: 10.1016/j.soard.2023.05.024
Open DOI Search in Google Scholar Back to article
Sepúlveda M, Alamo M, Saba J, Astorga C, Lynch R, Guzmán H. Long-term weight loss in laparoscopic sleeve gastrectomy. Surg Obes Relat Dis. 2017 Oct;13(10):1676-1681. doi: 10.1016/j.soard.2017.07.017
Open DOI Search in Google Scholar Back to article
Biter LU, Hart JW, Noordman BJ, et al. Long-term effect of sleeve gastrectomy vs Roux-en-Y gastric bypass in people living with severe obesity: a phase III multicentre randomised controlled trial (SleeveBypass). Lancet Reg Health Eur. 2024 Jan 22:38:100836. doi: 10.1016/j.lanepe.2024.100836
Open DOI Search in Google Scholar Back to article
Han Y, Jia Y, Wang H, Cao L, Zhao Y. Comparative analysis of weight loss and resolution of comorbidities between laparoscopic sleeve gastrectomy and Roux-en-Y gastric bypass: A systematic review and meta-analysis based on 18 studies. Int J Surg. 2020 Apr:76:101-110. doi: 10.1016/j.ijsu.2020.02.035
Open DOI Search in Google Scholar Back to article
Fazl Alizadeh R, Li S, Inaba CS, et al. Robotic versus laparoscopic sleeve gastrectomy: a MBSAQIP analysis. Surg Endosc. 2019 Mar;33(3):917-922. doi: 10.1007/s00464-018-6387-6
Open DOI Search in Google Scholar Back to article
Aeschbacher P, Garoufalia Z, Rogers P, et al. Laparoscopic versus robotic-assisted primary bariatric-metabolic surgery. Are we still expecting to overcome the learning curve? A propensity score-matched analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. Surg Obes Relat Dis. 2024 Sep;20(9):831-839. doi: 10.1016/j.soard.2024.03.017
Open DOI Search in Google Scholar Back to article
Brown A, Vu AH, Carey D, et al. Hospital charges for laparoscopic sleeve gastrectomy compared to robotic sleeve gastrectomy: a multicenter study. Surg Endosc. 2024 Sep;38(9):5304-5309. doi: 10.1007/s00464-024-11058-5
Open DOI Search in Google Scholar Back to article
Inaba CS, Koh CY, Sujatha-Bhaskar S, Gallagher S, Chen Y, Nguyen NT. Operative time as a marker of quality in bariatric surgery. Surg Obes Relat Dis. 2019 Jul;15(7):1113-1120. doi: 10.1016/j.soard.2019.04.010
Open DOI Search in Google Scholar Back to article
Abu dayyeh BK, Bazerbachi F, Vargas EJ, et al. Endoscopic sleeve gastroplasty for treatment of class 1 and 2 obesity (MERIT): a prospective, multicentre, randomised trial. Lancet. 2022 Aug 6;400(10350):441-451. doi: 10.1016/S0140-6736(22)01280-6.
Open DOI Search in Google Scholar Back to article
Marincola G, Gallo C, Hassan C, et al. Laparoscopic sleeve gastrectomy versus endoscopic sleeve gastroplasty: a systematic review and meta-analysis. Endosc Int Open. 2021 Jan;9(1):E87-E95. doi: 10.1055/a-1300-1085
Open DOI Search in Google Scholar Back to article
Lopez-Nava G, Asokkumar R, Bautista-Castaño I, et al. Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic greater curve plication: do they differ at 2 years? Endoscopy. 2021 Mar;53(3):235-243. doi: 10.1055/a-1224-7231
Open DOI Search in Google Scholar Back to article
Howard R, Chao GF, Yang J, et al. Comparative Safety of Sleeve Gastrectomy and Gastric Bypass Up to 5 years After Surgery in Patients With Severe Obesity. JAMA Surg. 2021 Dec 1;156(12):1160-1169. doi: 10.1001/jamasurg.2021.4981
Open DOI Search in Google Scholar Back to article
Aurora AR, Khaitan L, Saber AA. Sleeve gastrectomy and the risk of leak: a systematic analysis of 4,888 patients. Surg Endosc. 2012 Jun;26(6):1509-15. doi: 10.1007/s00464-011-2085-3
Open DOI Search in Google Scholar Back to article
Salminen P, Grönroos S, Helmiö M, et al. Effect of Laparoscopic Sleeve Gastrectomy vs Roux-en-Y Gastric Bypass on Weight Loss, Comorbidities, and Reflux at 10 years in Adult Patients With Obesity: The SLEEVEPASS Randomized Clinical Trial. JAMA Surg. 2022 Aug 1;157(8):656-666. doi: 10.1001/jamasurg.2022.2229
Open DOI Search in Google Scholar Back to article
Mason EE, Ito C. Gastric bypass in obesity. Surg Clin North Am. 1967 Dec;47(6):1345-51. doi: 10.1016/s0039-6109(16)38384-0
Open DOI Search in Google Scholar Back to article
Park CW, Torquati A. Physiology of weight loss surgery. Surg Clin North Am. 2011 Dec;91(6):1149-61, vii. doi: 10.1016/j.suc.2011.08.009
Open DOI Search in Google Scholar Back to article
Memon MA, Osland E, Mohamad R, Hoque Z, Alam K, Khan S. The effect of laparoscopic vertical sleeve gastrectomy and laparoscopic roux-en-Y gastric bypass on gastroesophageal reflux disease: An updated meta-analysis and systematic review of 5-year post-operative data from randomized controlled trials. Surg Endosc. 2024 Nov;38(11):6254-6269. doi: 10.1007/s00464-024-11303-x
Open DOI Search in Google Scholar Back to article
Adams TD, Davidson LE, Hunt SC. Weight and Metabolic Outcomes 12 years after Gastric Bypass. N Engl J Med. 2018 Jan 4;378(1):93-96. doi: 10.1056/NEJMc1714001
Open DOI Search in Google Scholar Back to article
Sharples AJ, Mahawar K. Systematic Review and Meta-Analysis of Randomised Controlled Trials Comparing Long-Term Outcomes of Roux-En-Y Gastric Bypass and Sleeve Gastrectomy. Obes Surg. 2020 Feb;30(2):664-672. doi: 10.1007/s11695-019-04235-2
Open DOI Search in Google Scholar Back to article
Singhal R, Cardoso VR, Wiggins T, et al. 30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data. Int J Obes (Lond). 2022 Apr;46(4):750-757. doi: 10.1038/s41366-021-01048-1
Open DOI Search in Google Scholar Back to article
Lee S, Carmody B, Wolfe L, et al. Effect of location and speed of diagnosis on anastomotic leak outcomes in 3828 gastric bypass cases. J Gastrointest Surg. 2007 Jun;11(6):708-13. doi: 10.1007/s11605-007-0085-3
Open DOI Search in Google Scholar Back to article
Bauman RW, Pirrello JR. Internal hernia at Petersen’s space after laparoscopic Roux-en-Y gastric bypass: 6.2% incidence without closure—a single surgeon series of 1047 cases. Surg Obes Relat Dis. 2009 Sep-Oct;5(5):565-70. doi: 10.1016/j.soard.2008.10.013
Open DOI Search in Google Scholar Back to article
Alexandrou A, Armeni E, Kouskouni E, Tsoka E, Diamantis T, Lambrinoudaki I. Cross-sectional long-term micronutrient deficiencies after sleeve gastrectomy versus Roux-en-Y gastric bypass: a pilot study. Surg Obes Relat Dis. 2014 Mar-Apr;10(2):262-8. doi: 10.1016/j.soard.2013.07.014
Open DOI Search in Google Scholar Back to article
Portela R, Marrerro K, Vahibe A, et al. Bile Reflux After Single Anastomosis Duodenal-Ileal Bypass with Sleeve (SADI-S): a Meta-analysis of 2,029 Patients. Obes Surg. 2022 May;32(5):1516-1522. doi: 10.1007/s11695-022-05943-y
Open DOI Search in Google Scholar Back to article
Verhoeff K, Mocanu V, Zalasky A, et al. Evaluation of Metabolic Outcomes Following SADI-S: a Systematic Review and Meta-analysis. Obes Surg. 2022 Apr;32(4):1049-1063. doi: 10.1007/s11695-021-05824-w
Open DOI Search in Google Scholar Back to article
Chen G, Zhang G, Peng B, Cheng Z, Du X. Roux-En-Y Gastric Bypass Versus Sleeve Gastrectomy Plus Procedures for Treatment of Morbid Obesity: Systematic Review and Meta-Analysis. Obes Surg. 2021 Jul;31(7):3303-3311. doi: 10.1007/s11695-021-05456-0
Open DOI Search in Google Scholar Back to article
Esparham A, Roohi S, Ahmadyar S, et al. The Efficacy and Safety of Laparoscopic Single-Anastomosis Duodeno-ileostomy with Sleeve Gastrectomy (SADI-S) in Mid- and Long-Term Follow-Up: a Systematic Review. Obes Surg. 2023 Dec;33(12):4070-4079. doi: 10.1007/s11695-023-06846-2
Open DOI Search in Google Scholar Back to article
Pereira SS, Guimarães M, Almeida R, et al. Biliopancreatic diversion with duodenal switch (BPD-DS) and single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) result in distinct post-prandial hormone profiles. Int J Obes (Lond). 2019 Dec;43(12):2518-2527. doi: 10.1038/s41366-018-0282-z
Open DOI Search in Google Scholar Back to article
Guimarães M, Pereira SS, Holst JJ, Nora M, Monteiro MP. Can Metabolite and Hormone Profiles Provide a Rationale for Choosing Between Bariatric Procedures? Obes Surg. 2021 May;31(5):2174-2179. doi: 10.1007/s11695-021-05246-8
Open DOI Search in Google Scholar Back to article
Wang T, Shen Y, Qiao Z, Wang Y, Zhang P, Yu B. Comparison of Diabetes Remission and Micronutrient Deficiency in a Mildly Obese Diabetic Rat Model Undergoing SADI-S Versus RYGB. Obes Surg. 2019 Apr;29(4):1174-1184. doi: 10.1007/s11695-018-03630-5
Open DOI Search in Google Scholar Back to article
Magouliotis DE, Tasiopoulou VS, Tzovaras G. One anastomosis gastric bypass versus Roux-en-Y gastric bypass for morbid obesity: a meta-analysis. Clin Obes. 2018 Jun;8(3):159-169. doi: 10.1111/cob.12246
Open DOI Search in Google Scholar Back to article
Robert M, Espalieu P, Pelascini E, et al. Efficacy and safety of one anastomosis gastric bypass versus Roux-en-Y gastric bypass for obesity (YOMEGA): a multicentre, randomised, open-label, non-inferiority trial. Lancet. 2019 Mar 30;393(10178):1299-1309. doi: 10.1016/S0140-6736(19)30475-1
Open DOI Search in Google Scholar Back to article
Cornejo J, Evans LA, Castillo-Larios R, Celik NB, Elli EF. One anastomosis gastric bypass as a primary bariatric surgery: MBSAQIP database analysis of short-term safety and outcomes. Surg Endosc. 2024 Jan;38(1):270-279. doi: 10.1007/s00464-023-10535-7
Open DOI Search in Google Scholar Back to article
Shah K, Nergård BJ, Fagerland MW, Gislason H. Limb Length in Gastric Bypass in Super-Obese Patients-Importance of Length of Total Alimentary Small Bowel Tract. Obes Surg. 2019 Jul;29(7):2012-2021. doi: 10.1007/s11695-019-03836-1
Open DOI Search in Google Scholar Back to article
Miras AD, Kamocka A, Perez-Pevida B, et al. The Effect of Standard Versus Longer Intestinal Bypass on GLP-1 Regulation and Glucose Metabolism in Patients With Type 2 Diabetes Undergoing Roux-en-Y Gastric Bypass: The Long-Limb Study. Diabetes Care. 2021 May;44(5):1082-1090. doi: 10.2337/dc20-0762
Open DOI Search in Google Scholar Back to article
Fisher DP, Johnson E, Haneuse S, et al. Association Between Bariatric Surgery and Macrovascular Disease Outcomes in Patients With Type 2 Diabetes and Severe Obesity. JAMA. 2018 Oct 16;320(15):1570-1582. doi: 10.1001/jama.2018.14619
Open DOI Search in Google Scholar Back to article
Aminian A, Zajichek A, Arterburn DE, et al. Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity. JAMA. 2019 Oct 1;322(13):1271-1282. doi: 10.1001/jama.2019.14231
Open DOI Search in Google Scholar Back to article
Wilson RB, Lathigara D, Kaushal D. Systematic Review and Meta-Analysis of the Impact of Bariatric Surgery on Future Cancer Risk. Int J Mol Sci. 2023 Mar 24;24(7):6192. doi: 10.3390/ijms24076192
Open DOI Search in Google Scholar Back to article
Wiggins T, Guidozzi N, Welbourn R, Ahmed AR, Markar SR. Association of bariatric surgery with all-cause mortality and incidence of obesity-related disease at a population level: A systematic review and meta-analysis. PLoS Med. 2020 Jul 28;17(7):e1003206. doi: 10.1371/journal.pmed.1003206
Open DOI Search in Google Scholar Back to article
Carlsson LMS, Sjöholm K, Jacobson P, et al. Life Expectancy after Bariatric Surgery in the Swedish Obese Subjects Study. N Engl J Med. 2020 Oct 15;383(16):1535-1543. doi: 10.1056/NEJMoa2002449
Open DOI Search in Google Scholar Back to article
Syn NL, Cummings DE, Wang LZ, et al. Association of metabolic-bariatric surgery with long-term survival in adults with and without diabetes: a one-stage meta-analysis of matched cohort and prospective controlled studies with 174 772 participants. Lancet. 2021 May 15;397(10287):1830-1841. doi: 10.1016/S0140-6736(21)00591-2
Open DOI Search in Google Scholar Back to article
Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-year Outcomes. N Engl J Med. 2017 Feb 16;376(7):641-651. doi: 10.1056/NEJMoa1600869
Open DOI Search in Google Scholar Back to article
Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. N Engl J Med. 2023 Dec 14;389(24):2221-2232. doi: 10.1056/NEJMoa2307563
Open DOI Search in Google Scholar Back to article
Salman AA, Salman MA, Marie MA, et al. Factors associated with resolution of type-2 diabetes mellitus after sleeve gastrectomy in obese adults. Sci Rep. 2021 Mar 16;11(1):6002. doi: 10.1038/s41598-021-85450-9
Open DOI Search in Google Scholar Back to article
Głuszyńska P, Diemieszczyk I, Szczerbiński Ł, Krętowski A, Major P, Razak Hady H. Risk factors for early and late complications after laparoscopic sleeve gastrectomy in one-year observation. J Clin Med. 2022 Jan 15;11(2):436. doi: 10.3390/jcm11020436
Open DOI Search in Google Scholar Back to article
Ebadinejad A, Shahshahani M, Hosseinpanah F, et al. Comparison of hypertension remission and relapse after sleeve gastrectomy and one-anastomosis gastric bypass: a prospective cohort study. Hypertens Res. 2023 May;46(5):1287-1296. doi: 10.1038/s41440-023-01180-7
Open DOI Search in Google Scholar Back to article
Zevallos A, Sanches EE, Parmar C, Ribeiro R, Pouwels S. Remission of hypertension after laparoscopic sleeve gastrectomy versus Roux-en-Y-gastric bypass: a systematic review of randomized control trials. Surg Obes Relat Dis. 2024 Oct 12;S1550-7289(24)00851-7. doi: 10.1016/j.soard.2024.10.010
Open DOI Search in Google Scholar Back to article
McTigue KM, Wellman R, Nauman E, et al. Comparing the 5-year diabetes outcomes of sleeve gastrectomy and gastric bypass: the National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study. JAMA Surg. 2020 May 1;155(5):e200087. doi: 10.1001/jamasurg.2020.0087
Open DOI Search in Google Scholar Back to article
Balasubaramaniam V, Pouwels S. Remission of type 2 diabetes Mellitus (T2DM) after sleeve gastrectomy (SG), one-anastomosis gastric bypass (OAGB), and roux-en-Y gastric bypass (RYGB): a systematic review. Medicina (Kaunas). 2023 May 19;59(5):985. doi: 10.3390/medicina59050985
Open DOI Search in Google Scholar Back to article
van der Laan L, Sizoo D, van Beek AP, Emous M; Dutch Audit for Treatment of Obesity Research Group. Comparable results 5 years after one anastomosis gastric bypass compared to Roux-en-Y gastric bypass: a propensity-score matched analysis. Surg Obes Relat Dis. 2024 Oct 5:S1550-7289(24)00814-1. doi: 10.1016/j.soard.2024.09.009
Open DOI Search in Google Scholar Back to article
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 Jul;33(7):2194-2209. doi: 10.1007/s11695-023-06602-6
Open DOI Search in Google Scholar Back to article
Benotti P, Wood GC, Winegar DA, et al. Risk factors associated with mortality after Roux-en-Y gastric bypass surgery. Ann Surg. 2014 Jan 1;259(1):123-30. doi: 10.1097/SLA.0b013e31828a0ee4
Open DOI Search in Google Scholar Back to article
Thomopoulos T, Mantziari S, Joliat GR. Long-term results of Roux-en-Y gastric bypass (RYGB) versus single anastomosis duodeno-ileal bypass (SADI) as revisional procedures after failed sleeve gastrectomy: a systematic literature review and pooled analysis. Langenbeck’s Arch Surg. 2024 Nov 23;409(1):354. doi: 10.1007/s00423-024-03557-9
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.14797/mdcvj.1513 | Journal eISSN: 1947-6108

Journal RSS Feed

Language: English

Page range: 84 - 93

Submitted on: Oct 28, 2024

Accepted on: Dec 2, 2024

Published on: Feb 18, 2025

Published by: Houston Methodist DeBakey Heart & Vascular Center

In partnership with: Paradigm Publishing Services

Keywords:

bariatric surgery,

sleeve gastrectomy,

Roux-en-Y gastric bypass,

obesity,

cardiovascular disease

© 2025 Connie Au, Robert Brumer, Julia Schroer, Nabil Tariq, published by Houston Methodist DeBakey Heart & Vascular Center
This work is licensed under the Creative Commons Attribution-NonCommercial 4.0 License.

Volume 21 (2025): Issue 2