Gastric bypass and its role in metabolic and bariatric surgery

Abstract

Introduction: Historically, gastric bypass (GB) has been the oldest procedure used in bariatric surgery. Even though technically demanding, it had been the most widely used method for decades worldwide and still holds an irreplaceable position for its pronounced and long-term metabolic effect as well as for the therapeutic effect in gastroesophageal reflux (GERD).
Method: The authors retrospectively analyse a series of 268 cases of GB, focusing on short-term weight loss, the metabolic effect on type two diabetes (T2DM), complication and reoperation rates and the BAROS scoring system in Roux-en-Y bypass (RYGB) and in minigastric bypass with one anastomosis (MGB/OAGB), comparing both of them to more frequently used gastric plication and sleeve gastrectomy.
Results: Both GB, without any increase in complication and reoperation rates, lead to a higher weight loss and the best BAROS scoring in comparison to other, simpler restrictive procedures. One year after GB, resolution of T2DM is seen in most diabetes patients operated on, the number needed to treat being <2.
Conclusion: GB are safe and effective in short term and later, more than two years after surgery, show an excellent result according to the BAROS scoring. Excellent outcomes are reached particularly in compliant patients with T2DM, with GERD and in reoperations. In most diabetes patients, the unique metabolic effect of GB results in remission of otherwise incurable T2DM and significantly changes the position of surgery within diabetology. The authors call for a systematic nationwide evidence of long-term results in MB surgery and for conceptual development of surgical treatment of T2DM in centers of MB surgery.