Bariatric surgery today: the good, the bad, and the ugly

Abstract

Background: Metabolic surgery has changed significantly over the last 70 years. While the field has evolved and the long-term data continues to be pub-lished, we are beginning to appreciate the full spectrum of the effects of bariatric surgery in addition to weight loss. Methods: Here we review the literature from the 2015 and 2016 and present our perspective of the good, the bad, and the ugly side of bariatric surgery and how they have contributed to the field over the years. Results: Weight loss and remission of comorbidities are the reasons for success in bariatric surgery. With a plethora of long-term data being published recently, the extent of benefit that bariatric surgery provides is growing. Contrary to the good, complications from surgery and endoscopic bariatric therapies continue to be det-rimental to our patients, but remain the impetus for improvement. Conclusions: We conclude by briefly touching on the physio-logic and psychosocial aspects of bariatric surgery that are driving the future of the field, namely the biochemical changes created by bariatric surgery, predicting the population of patients who will fail their initial intervention, and how revisional surgery has become more commonplace in the long-term.