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a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2019; 73(6): 468–471. doi:10.14735/amgh2019468.

Surgical treatment of obesity and metabolic disorders – new challenges for different specializations

Martin Fried1

+ Affiliation


Methods of bariatric and metabolic surgery have experienced major changes over the past 7 decades. One of the most important changes was the introduction of laparoscopic/minimally invasive approaches in the early 1990s, resulting in the more widespread performance of bariatric surgery worldwide. The shift from bariatric surgery to metabolic surgery is regarded as another substantial change in treatment, as the most important measure of success in metabolic surgery is the improvement or remission of metabolic parameters, such as type 2 diabetes mellitus and hypertension, rather than weight loss on its own. Despite increasing numbers of bariatric and metabolic procedures, only a small proportion of potentially eligible patients undergo these treatments. Reasons for refusal include concerns of both patients and referring physicians of the risks and excessive invasiveness of these procedures, their irreversible anatomical changes, and distrust in treatment results. New technical developments and treatment algorithms target these concerns, with the goal being to use less invasive surgical methods, and to directly involve different medical specialties and treatments. Examples include gastroenterologists performing endoscopic gastric plication or partial jejunal bypass, as well embolization of the left gastric artery. Patients generally prefer less invasive treatments, although it may result in moderate effectiveness, rather than highly infective, but highly invasive, riskier  treatment.


bariatric and metabolic surgery, type 2 diabetes, new therapeutical approaches

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