Outcomes of Metabolic Surgery

Abstract

The concept of “metabolic surgery” has evolved to indicate a surgical approach aimed at controlling of metabolic illnesses, and not just excess weight. Demographic characteristics, prevalence, and severity of diabetes and cardiovascular disease differ substantially in patients who present for metabolic surgery compared to those who seek conventional bariatric surgery for weight loss. Such differences have important ramifications for preoperative and postoperative patient management as well as outcomes of metabolic surgery. While for decades excess weight loss (EWL) has been a traditional measure of the efficacy of bariatric surgery, remission/improvement of metabolic disease (type 2 diabetes mellitus, hypertension, obstructive sleep apnea, dyslipidemia) and cardiovascular risk reduction are more rational measures of outcomes in metabolic surgery. This chapter aims to define the role of metabolic surgery, review the effects of gastrointestinal surgery on metabolic outcomes from retrospective and observational studies, and review the outcomes of metabolic surgery from prospective randomized controlled trial data.