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The ASMBS Textbook of Bariatric Surgery pp 329–340Cite as

Operation of Choice for Metabolic Surgery

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Abstract

Guiding patients toward the most appropriate metabolic procedure for the treatment of chronic disease of obesity, type 2 diabetes mellitus (T2DM), and their complications is important for improving outcomes. The four standard metabolic procedures have their own risks and benefits. Available clinical trials demonstrate the presence of an antidiabetic efficacy gradient among standard metabolic operations (BPD-DS > RYGB ≥ SG > AGB). More extensive procedures, such as BPD-DS, are generally associated with greater weight loss and more profound metabolic effects but at the cost of more surgical complications. The individualized metabolic surgery (IMS) score is an evidence-based and validated prediction tool which can assist in a personalized selection process between the RYGB and SG for T2DM.

Nonetheless, the procedure selection should not be solely based on T2DM-related outcomes. Diabetes is one outcome, one of the many outcomes that needs to be considered in decision-making. The surgical risk, differential impact of each procedure on body weight and other obesity-related diseases, presence of other medical and mental problems, behavioral factors, medications, and patient’s values and goals should be considered when the patient and medical team make a shared decision about the most appropriate surgical procedure.

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Authors and Affiliations

  1. Department of General Surgery, Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, OH, USA

    Ali Aminian & Philip R. Schauer

Authors
  1. Ali Aminian
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  2. Philip R. Schauer
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Correspondence to Ali Aminian .

Editor information

Editors and Affiliations

  1. Department of Surgery, Division of Gastrointestinal Surgery, University of California, Irvine Medical Center, Orange, CA, USA

    Ninh T. Nguyen

  2. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Stacy A. Brethauer

  3. Bariatric and Minimally Invasive Surgery Division, Yale School of Medicine, New Haven, CT, USA

    John M. Morton

  4. Bariatric Surgery, Metabolic and Bariatric Care, CHI Memorial Hospital, Chattanooga, TN, USA

    Jaime Ponce

  5. Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, FL, USA

    Raul J. Rosenthal

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Aminian, A., Schauer, P.R. (2020). Operation of Choice for Metabolic Surgery. In: Nguyen, N., Brethauer, S., Morton, J., Ponce, J., Rosenthal, R. (eds) The ASMBS Textbook of Bariatric Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-27021-6_30

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  • DOI: https://doi.org/10.1007/978-3-030-27021-6_30

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-27020-9

  • Online ISBN: 978-3-030-27021-6

  • eBook Packages: MedicineMedicine (R0)

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