At present, the international bariatric surgery mainly includes: (1) restrictive surgery: AGB, SG and gastric curvature and plication; (2) Restrictive binding absorption reduction surgery: RYGB and BPD (including DS); (3) Simple absorption reduction surgery: DJB. At present, due to the high incidence of diarrhea and vitamin deficiency, BPD has not been modified in China. For the actual situation in China, the main weight-loss surgeries are: OAGB, RYGB, SG and DJB, especially the sleeve stomach and gastric bypass.
Sleeve gastrectomy (SG) Since the 90s, sleeve gastrectomy (SG) has been on the rise. The surgical method of SG is to separate the gastric wall and omentum at the greater curvature of the stomach, up to the esophageal-gastric junction, and down to about 4 cm proximal to the pylorus. Under the guidance of the gastric support tube, the sleeve gastrectomy was performed from 4cm above the pylorus to the small curved side until the angle of his, and the stomach was cut into a tube, and the residual gastric volume was about 100ml. In terms of weight loss, the %EWL of patients after LSG was 559%；In terms of glycemic control, the remission rate of diabetic patients after SG surgery was 78%. Sleeve gastrectomy is a safe and effective bariatric surgical method, which is commonly used in China.
Roux-en-Y anastomosis (i.e., Roux-en-Y gastric bypass, RYGB)The surgical method of RYGB is to create a small gastric pouch by cutting the stomach and perform a gastric pouch-jejunal roux-en-y anastomosis. This surgical procedure leaves most of the stomach and proximal small intestine vacated through the reconstruction of the digestive tract, resulting in the dual effects of restriction of intake and malabsorption. The %EWL of patients with RYGB was 64%, and the 1-year remission rate for patients with type 2 diabetes reached 93%. The remission rate of diabetes mellitus is higher than that of other surgeries, so it is the preferred surgical method for patients with diabetes and obesity. Duodenal-jejunal bypass (DJB) The surgical method of DJB is as follows: the beginning of the duodenum is severed from 2cm below the pylorus, the jejunum is severed from 30cm below the ligament of the flex, the proximal jejunum is anastomosed about 50cm below the jejunal severe, and the distal jejunum is anastomosed with the proximal end of the duodenum.
The vast majority (>85%) of simply obese patients with metabolic syndrome may choose LSG. LRYGB is a surgical method that simultaneously restricts intake and reduces absorption, and in addition to significant weight loss, it can improve glucose metabolism and other metabolic indicators. LRYGB has a high remission rate for T2DM, which may be related to its effects on pancreatic islet cell function by altering gastrointestinal hormone secretion and duodenal openness. For obese patients with moderate to severe reflux esophagitis or metabolic syndrome, or those who are super obese, LRYGB may be preferred.
Each procedure has its own suitability and advantages and disadvantages, and the choice of surgery needs to be decided based on the patient's specific situation and the doctor's recommendation. Before undergoing surgery, patients should fully understand the principle, process, risks and effects of surgery, and be mentally and physically prepared. After undergoing surgery, patients should follow their doctor's instructions, make lifestyle changes, stick to a reasonable diet and exercise, check their physical condition regularly, and maintain a good attitude in order to benefit from the surgery. Bariatric surgery