Bariatric surgery for treatment of morbid obesity in adults

Abstract

Morbid obesity requires active intervention, with treatment options including lifestyle modification, pharmacotherapy, and surgery. As the prevalence of obesity continues to rise in Korea, it is crucial for specialists and general practitioners to have a comprehensive understanding of obesity and its management. Bariatric surgery is the most effective treatment modality for obesity, leading to significant weight loss and metabolic benefits. It involves surgical alterations of normal anatomical structures to improve overall health. Therefore, selecting the appropriate procedure based on the individual characteristics of patients is crucial. This review highlights the two most commonly performed bariatric procedures worldwide, including in Korea: sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Furthermore, it provides a comprehensive overview of the surgical techniques involved in SG and RYGB, addresses potential complications, and presents findings from key studies on the weight loss and metabolic outcomes of these surgeries. Additionally, to support clinical application, the review provides outcome data for these procedures based on studies conducted in Korean populations. In addition to SG and RYGB, this review briefly introduces other surgical and endoscopic options, as well as pharmacological treatments that are currently available or may become viable options in the near future.

Keywords: Bariatric surgery; Metabolic effect; Morbid obesity; Weight loss.

Figure 1

Scheme and surgical images of laparoscopic sleeve gastrectomy. (A) Schematic representation of sleeve gastrectomy. (B) Dissection of the entire greater curvature of the stomach. (C) Maintenance of a 5 cm distance from the pylorus. (D) Division of the stomach from the antrum to the angle of His using sequential stapler firings. (E) Creation of the gastric sleeve. Created with BioRender.com.

Figure 2

Scheme and surgical images of laparoscopic Roux-en-Y gastric bypass. (A) Schematic representation of Roux-en-Y gastric bypass. (B) Creation of the gastric pouch through horizontal and vertical stapling. (C) Use of a 34–36 Fr bougie to achieve a gastric pouch volume of 25–30 cm³. (D) Performance of a side-to-side gastrojejunostomy with a length < 3 cm. (E) Performance of a side-to-side jejunojejunostomy. Created with BioRender.com.