[Bariatric metabolic surgery 2025].

Abstract

Surgical procedures form an integral part of the interdisciplinary treatment of morbid obesity and its associated complications. The objective goes beyond mere weight control (bariatric surgery) and includes controlling the entire metabolism. Bariatric/metabolic procedures have not only become the currently most effective form of treatment for diabetes mellitus type 2 (DMT2) particularly in obese patients, but it has also proven to be a key tool for many other obesity-related secondary diseases. In addition to the main modes of action, i.e., restriction and malabsorption, numerous other mechanisms are the subject of research, since the metabolic effects in particular occur in the early postoperative period and can also be demonstrated in non-obese individuals. Today, a variety of surgical procedures are available to help address patient-specific issues. Examples include sleeve gastrectomy, Roux-en‑Y gastric bypass, omega loop bypass, single anastomosis duodeno-ileal bypass (SADI) surgery, single anastomosis sleeve-ileal bypass (SASI) surgery, biliopancreatic diversion with duodenal switch (BPD-DS), gastric band, and purely endoscopic procedures such as intragastric balloon or endoscopic sleeve gastroplasty (ESG). Long-term, structured, and preferably multidisciplinary follow-up care is essential for a positive long-term outcome and should include: nutritional therapy, laboratory tests, adjustment of pharmacotherapy, encouragement to take part in cancer screening, as well as vigilance regarding neurological symptoms and critical treatment situations such as weight regain, recurrence of depression or addiction problems.