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How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?

Title: How do patients' clinical phenotype and the physiological mechanisms of the operations impact the choice of bariatric procedure?
Authors: Bächler, T
Le Roux, CW
Bueter, M
Item Type: Journal Article
Abstract: Bariatric surgery is currently the most effective option for the treatment of morbid obesity and its associated comorbidities. Recent clinical and experimental findings have challenged the role of mechanical restriction and caloric malabsorption as the main mechanisms for weight loss and health benefits. Instead, other mechanisms including increased levels of satiety gut hormones, altered gut microbiota, changes in bile acid metabolism, and/or energy expenditure have been proposed as explanations for benefits of bariatric surgery. Beside the standard proximal Roux-en-Y gastric bypass and the biliopancreatic diversion with or without duodenal switch, where parts of the small intestine are excluded from contact with nutrients, resectional techniques like the sleeve gastrectomy (SG) have recently been added to the armory of bariatric surgeons. The variation of weight loss and glycemic control is vast between but also within different bariatric operations. We surveyed members of the Swiss Society for the Study of Morbid Obesity and Metabolic Disorders to assess the extent to which the phenotype of patients influences the choice of bariatric procedure. Swiss bariatric surgeons preferred Roux-en-Y gastric bypass and SG for patients with type 2 diabetes mellitus and patients with a body mass index >50 kg/m(2), which is consistent with the literature. An SG was preferred in patients with a high anesthetic risk or previous laparotomy. The surgeons' own experience was a major determinant as there is little evidence in the literature for this approach. Although trends will come and go, evidence-based medicine requires a rigorous examination of the proof to inform clinical practice.
Issue Date: 22-Jul-2016
Date of Acceptance: 24-May-2016
URI: http://hdl.handle.net/10044/1/39298
DOI: https://dx.doi.org/10.2147/CEG.S87205
ISSN: 1178-7023
Publisher: Dove Medical Press
Start Page: 181
End Page: 189
Journal / Book Title: Clinical and Experimental Gastroenterology
Volume: 2016
Issue: 9
Copyright Statement: This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.
Sponsor/Funder: ONO Pharmaceuticals Co Ltd
Funder's Grant Number: N/A
Keywords: bariatric procedures
choice of type of surgery
underlying physiology
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Department of Medicine (up to 2019)