Bariatric Surgical Techniques: How to Choose?
DOI:
https://doi.org/10.34635/rpc.1141Keywords:
Bariatric Surgery, Obesity/drug therapy, Obesity/surgeryAbstract
Bariatric and metabolic surgery remains the most effective and durable treatment for severe obesity and its multiple metabolic and mechanical comorbidities. However, the growing range of effective procedures raises a central question: how to select the most appropriate technique for each patient? This review critically examines recent literature (2021-2025), including the updated ASMBS/IFSO guidelines, intending to summarize the principles, outcomes, and indications of the main bariatric procedures. Sleeve gastrectomy (SG) has consolidated its position as the most widely performed procedure worldwide due to its simplicity and safety. Roux-en-Y gastric bypass (RYGB) remains the reference technique in patients with long-standing type 2 diabetes or gastroesophageal reflux disease (GERD), despite a higher risk of nutritional deficiencies. Procedures with greater metabolic potency—one-anastomosis gastric bypass (OAGB), biliopancreatic diversion/duodenal switch (BPD/DS), and single-anastomosis duodenal bypass with sleeve gastrectomy (SADI-S)—achieve superior weight and metabolic outcomes, though they require stringent nutritional surveillance. Emerging operations such as intestinal bipartition and novel endoscopic interventions expand the therapeutic spectrum but should be performed only in specialized, high-volume centers and within structured clinical protocols. Surgical choice must be individualized, integrating clinical-metabolic phenotype (BMI, GERD, diabetes, steatohepatitis, age), operative risk, patient preference, and the expertise of the multidisciplinary team. Success should be measured beyond weight loss, encompassing remission of comorbidities, preservation of lean mass, and improved quality of life. There is no universally ideal operation. The decision should rely on clinical, metabolic, and functional criteria, supported by experienced teams and robust quality programs. The future of bariatric surgery will be driven by the integration of surgical, pharmacological, and endoscopic strategies within a framework of personalized metabolic medicine—potentially enhanced by artificial intelligence-based algorithms.
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