Procedure and patient selection in bariatric and metabolic surgery

INTRODUCTION: Sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB) are the commonest bariatric procedures performed worldwide. The purpose of this review was to analyze comparative data on these three procedures to aid patient and procedure selection for patients seeking bariatric and metabolic surgery (BMS). EVIDENCE ACQUISITION: We examined published English language scientific literature available on PubMed for data comparing SG, RYGB, and OAGB for various groups of patients. EVIDENCE SYNTHESIS: There are a number of variables that can influence patient and procedure selection for individuals seeking BMS. High-quality data comparing each of these procedures for every patient subgroup, for each possible outcome measure is lacking. It is, therefore, not currently possible to make strict recommendations regarding patient and procedure selection. At the same time, the multidisciplinary teams should understand that risks of surgery may simply be too high for some patients - such as those suffering from end-stage organ disease and those suffering from mega obesity (BMI >= 70 kg/m(2)). Surgery should only be offered to such high-risk groups in dedicated centers with appropriate expertise. For other patients, surgeons should carefully consider the pros and cons of each procedure, their own experience, and patient preferences before deciding the most appropriate BMS procedure for them. CONCLUSIONS: This review examines various factors influencing patient and procedure selection in bariatric surgery. Authors feel it is currently not possible to make strict recommendations and surgeons should carefully discuss the pros and cons of bariatric surgery and that of various options available in their practice with the patients before making a final recommendation.