
Am Fam Physician. 2022;105(6):593-601
Related Letter to the Editor: Alcohol Use Disorder Following Metabolic Surgery
Author disclosure: A public database shows that Dr. Harrison has attended an industry-sponsored training course for robotic-assisted surgery; this is considered standard practice and is required to use the surgical platform in bariatric surgery. He has not served as a speaker or consultant for this company. Drs. Banerjee and Schroeder have no relevant financial relationships.
In 2019, approximately 256,000 metabolic surgery procedures were performed in the United States, a 32% increase since 2014. The most common procedures are the laparoscopic sleeve gastrectomy and the Roux-en-Y gastric bypass. Choice of procedure depends on concurrent medical conditions, patient preference, and expertise of the surgeon. These procedures have a mortality risk of 0.2% to 0.3%. On average, weight loss of 30 to 50 kg (66 to 110 lb), or a 20% to 30% reduction in total body weight, is achieved, although most patients will experience some weight regain three to 10 years after surgery. In patients who have had metabolic surgery, all-cause mortality is reduced by 30% to 45% at two to 15 years postsurgery compared with patients with obesity who did not have surgery. Approximately 70% of surgical patients achieve remission of type 2 diabetes, and over 30% of surgical patients maintain remission at 10 years. [corrected] Other obesity-related conditions are also greatly reduced, and quality of life improves. Postoperatively, patients require standardized nutritional supplementation and surveillance. Persistent changes in diet, such as consuming protein first at every meal, regular physical activity, and ongoing attention to behavior change are critical for the success of the patient after metabolic surgery. Common adverse outcomes include surgical complications, nutritional deficiencies, bone density loss, dumping syndrome, gastroesophageal reflux disease, and loose skin. The family physician is well positioned to counsel patients about metabolic surgical options and the risks and benefits of surgery and to provide long-term support and medical management for postsurgery patients.
What Procedures Are Commonly Performed?
EVIDENCE SUMMARY
The sleeve gastrectomy procedure resects most of the body and all of the fundus of the stomach, creating a long, narrow, tubular stomach (Figure 18). Single anastomosis duodenal-ileal bypass with sleeve was endorsed by the American Society for Metabolic and Bariatric Surgery in 2020 and will likely become more prevalent in the coming years.9 Single anastomosis duodenal-ileal bypass with sleeve adds a bypass of the duodenum to traditional sleeve, which can be performed as a single procedure or as a revision to a prior sleeve gastrectomy (Figure 2).




How Does Metabolic Surgery Lead to Weight Loss and Improvement in Type 2 Diabetes?
EVIDENCE SUMMARY
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