Surgery Options

Bariatric Surgery: Surgical Options and Outcomes

  • Bariatric surgery should be considered for patients with body mass index (BMI) ≥ 40 kg/m2 and patients with a BMI ≥ 35 kg/m2 and at least one adiposityrelated disease.
  • Bariatric surgery could be considered for patients with BMI ≥ 30 kg/m2 with an uncontrolled obesityrelated disease refractory to medical management.
  • The choice of bariatric procedure should be tailored to patients’ needs and based on a collaborative, multidisciplinary discussion of risk, benefit and side effects.
  • Several procedures are currently performed in Ireland (sleeve gastrectomy, gastric bypass, adjustable gastric banding, intra-gastric balloon and others), but variations exist. Laparoscopic gastric banding is no longer routinely performed.
  • For patients with complicated obesity, surgery offers superior outcomes compared to best medical management in terms of quality of life, longterm weight loss and resolution or improvement of obesity-related complications, primarily type 2 diabetes mellitus, obstructive sleep apnoea, nonalcoholic fatty liver disease and hypertension.
  • A laparoscopic surgical approach should be standard and is associated, for most patients, with a low mortality rate (< 0.1%) and a low rate of serious complications (< 5%).
  • Bariatric surgery improves life expectancy.
  • Novel surgical and endoscopic approaches are being used and developed and can represent an option for selected patients.
  1. Bariatric surgery can be considered for people with body mass index (BMI) ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 with at least one adiposity-related disease (Level 4, Grade D, Consensus) to:
    1. Reduce long-term overall mortality (Level 2b, Grade B) 1,2;
    2. Induce significantly better long-term weight loss compared to medical management alone (Level 1a, Grade A)3;
    3. Induce control and remission of type 2 diabetes mellitus (T2DM), in combination with best medical management, over best medical management alone (Level 2a, Grade B)4,5;
    4. Significantly improve quality of life (Level 3, Grade C)6; and
    5. Induce long-term improvement or remission of most obesity-related diseases, including dyslipidaemia (Level 3, Grade C)7, hypertension (Level 3, Grade C)8, liver steatosis and non-alcoholic steatohepatitis (Level 3, Grade C)9.
  2. Bariatric surgery should be considered in patients with BMI between 30 kg/m2 – 35 kg/m2 with inadequately controlled T2DM despite optimal medical management (Level 1a; Grade A)10.
  3. Bariatric surgery may be considered to facilitate weight loss and management of obesity-related disease in persons with BMI between 30 kg/m2 – 35 kg/m2, in whom optimal medical and behavioural management has been insufficient to produce significant or sufficient weight loss (Level 2a, Grade B)11.
  4. We suggest the choice of bariatric procedure be decided according to the patient’s need, in collaboration with an experienced inter-professional team (Level 4, Grade D, Consensus).
  5. We suggest that adjustable gastric banding not be offered due to unacceptable complications and long-term failure (Level 4, Grade D)12.
  • If you live with obesity (when the amount or location of adipose or fat tissue in your body causes health problems), bariatric surgery may be an appropriate treatment option for you. Behavioural interventions and obesity medications are often not effective enough to obtain significant long-term weight loss and remission of obesity-related diseases.
  • Bariatric surgery combined with healthy behaviours can result in significant long-term weight loss (20% – 40% of your body weight) and improvement of obesity-related disease, including type 2 diabetes, sleep apnoea, fatty liver disease and hypertension.
  • Different surgical options exist with varying levels of effectiveness. You should have an extensive discussion with your multi-disciplinary healthcare team before deciding which option may provide the greatest benefit.
  • All bariatric surgeries have adverse effects and potential risks and require lifelong follow-up to monitor mineral and vitamin supplementation and support for healthy behaviours.

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