Table 3.
The effects of bariatric surgery on managing obesity and DM.
| Treatment | Mechanism of action (Not exhaustive) | Efficacy in weight loss/glycemic control | Advantages | Disadvantages | Impact on body weight/glycemic traits | Refs |
|---|---|---|---|---|---|---|
| Sleeve gastrectomy (SG) | ① Gastric volume↓ ② Fastened gastric emptying ③ Food intake and calorie consumption↓ ④ GI hormones (ghrelin) ↓ ⑤ Appetite↓ ⑥ Satiety↑ |
1 year: 20-28% ≥6 Years: 22% |
① Easier procedure Tends to avoid iron calcium and vitamin deficiencies ② Rapid and substantial weight loss ③ No foreign material implanted ④ Can be used as the initial procedure before RYGB or BPD–DS |
① Risk of gastric leaks ② Late complications requiring conversion to RYGB ③ Weight regain due to dilated sleeve ④ Increased risk of postoperative GERD |
① Popularity: SG>RYGB>AGB>BPD-DS ② Efficacy of weight loss and T2DM remission: BPD-DS>RYGB>SG>AGB ③ Complications: BPD-DS>RYGB>SG>AGB ④ Common mechanisms: Changes in hunger, satiety, energy balance, gastric pouch emptying rates, vagal signaling, GI hormone activity, circulating BAs, and the gut microbiome, Changes in inflammatory and adipokine profiles |
(10, 28, 155, 162, 177, 180–182) |
| Roux-en-Y gastric bypass (RYGB) | ① Food and calories consumption↓ ② Fat malabsorption ③ Calories and nutrients absorption↓ ④ Anti-incretin substances↓ ⑤ Incretin substance secretion↑ ⑥ Insulin sensitivity↑ |
1 year: 23-43% ≥6 Years: 25-28% |
Notable long-term weight loss and glycemic control | ① Complexity ② Long-term vitamin and/or mineral deficiencies ③ Longer hospital stay ④ Higher perioperative and late complications |
||
| Adjustable gastric band (AGB) | ① Satiety↑ ② Delayed gastric emptying |
1 year: 14-30% ≥6 Years: 13-14% |
① No surgical division of the stomach ② Shorter operative time ③ Reversibility and adjustability ④ Lower risk of vitamin and/or mineral malabsorption ⑤ Lower rate of death and perioperative complications |
① Higher rate of reoperation for obstruction, band slippage or erosion ② Device vulnerability ③ Risk of band obstruction |
||
| Biliopancreatic diversion with duodenal switch (BPD-DS) | ① Food consumption↓ ② Absorption of protein, fat, nutrients, and vitamins↓ ③ Changes in GI hormones |
<2 years: 48-64% ≥2 Years: 69-78% |
① Highest weight loss and improvement in glucose metabolism ② Highest rate of remission of T2DM |
① Complexity ② Higher complication rates and mortality ③ Potential deficiencies in proteins, vitamins, and minerals ④ Frequent follow-up required |
||
| Single-anastomosis duodenal ileostomy with sleeve gastrectomy (SADI-S) | Similar to SG | 21.5-41.2%, Without weight regain within 24 months after surgery |
① Safe ② More simplified technique and less complications compared to BPD-DS ③ Shorter hospitalization ④ Strengthened efficacy in weight loss and glycemic control for patients with morbid obesity |
① Complexity ② Higher complication rates ③ Potential deficiencies in in total serum proteins, folate, vitamin B12, calcium, and zinc |
DM remission rate is up to nearly 75% | |
| One anastomosis gastric bypass (OAGB) | ① Food intake and calorie consumption↓ ② Altered GI hormones↓ ③ Appetite↓ ④ Satiety↑ ⑤ Insulin sensitivity↑ |
EBMIL at a mean time of 3.2 ± 4.4 years: ① Revisional operations: 79.14 ± 14.8 ② Primary operations: 83.77 ± 13.41 |
① Safe ② Higher efficacy in weight loss and DM remission than RYGB and SG, respectively ③ Shorter operative time ④ Less complications |
① Potential risk of bile reflux and stomal cancer ② Longer follow-ups and more data are required |
① Weight reduction: AOGB≈RYGB>SG ② Average DM remission: 75.8% ± 12.2 at a mean time of 2.9 ± 3.4 years |
(T2) DM, (type 2) diabetes mellitus; EBMIL, excess body mass index loss.