**1.2 The most commonly performed bariatric surgical procedures**


The mechanism of action of bariatric surgical procedures is related to the complex interactions between gastric resection and malabsorption as well as the hormonal and neural signals affecting hunger and satiety. Buchwald et al. [3] reported the rate of improvement in diabetes with bariatric surgery as 56.7, 79.7, 80.3, and 95.1% following adjustable gastric band (AGB), Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch (BPD-DS), respectively, in a meta-analysis. Complete diabetes remission was observed in 78% of the patients. The lipid profile is also improved in 70% of the patients after bariatric surgery. The total cholesterol, LDL, and triglyceride levels are decreased, but no significant change has been reported for HDL levels.

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**Figure 1.**

*Roux-en-Y gastric bypass.*

*Treatment Options in Morbid Obesity*

(0.3–0.6%) [4].

*DOI: http://dx.doi.org/10.5772/intechopen.88823*

**2. Laparoscopic Roux-en-Y gastric bypass (LRYGB)**

Mortality rates in bariatric surgical procedures are equal to those observed with small intra-abdominal operations such as laparoscopic cholecystectomy

LRYGB is the most commonly used restrictive method. It is reported to be the gold standard in the surgical treatment of morbid obesity as it provides long-term weight loss and has acceptable morbidity and mortality [5]. The gastric bypass method in bariatric surgery was first suggested by Edward E. Mason [6]. While 90% of the stomach volume is reduced, malabsorption is ensured by bypassing the duodenum in this method. The main aim is to create a proximal small-volume (<20 ml) gastric pouch that is completely detached from the stomach (**Figure 1**). The Roux limb can be pulled up from the front of the colon and stomach, from the front of the colon and the back of the stomach, or from the back of the colon and stomach for gastrojejunostomy. Transoral circular stapling, linear stapling, manual suturing, or transgastric circular stapling can be used for gastrojejunostomy. The biliopancreatic limb is prepared at a length of 50 cm and the Roux limb at a length of 100–150 cm distal to the Treitz ligament. Once the stomach is cut perpendicularly to the small curvature and 3–5 cm distal to the esophagogastric junction with a linear stapler (60 mm long and 3.8 mm thick), the pouch is formed by completing the cutting action toward the angle of His. Postoperative fluid support and ensuring adequate urine output are very important. The results and any nutritional deficiency should be checked at the postoperative third week, the third and sixth months, and the first year [7]. These patients lose 60–80% of their extra weight within 1 year after the surgery. Consequently, a significant improvement is seen in

*Obesity*

**1.1 Bariatric surgery indications**

• Acceptable surgical risk

result of the surgery

• Restrictive procedures

• Sleeve gastrectomy (SG)

• Jejunoileal bypass (JIB)

• Vertical banded gastroplasty (VBG)

• Absorption-disrupting procedures

• Biliopancreatic diversion (BPD)

• Roux-en-Y gastric bypass (RYGB)

change has been reported for HDL levels.

• Duodenal switch (DS) along with BPD

• Unsuccessful nonsurgical treatments

or the presence of additional disease (type 2 diabetes, hyperten-

sion, sleep apnea, hyperlipidemia) together with BMI >35 kg/m2

• Being psychologically stable and lack of alcohol or drug addiction

• Lack of uncontrolled psychotic and depressive disorders

**1.2 The most commonly performed bariatric surgical procedures**

• Combined restrictive and absorption-disruptive procedures

The mechanism of action of bariatric surgical procedures is related to the complex interactions between gastric resection and malabsorption as well as the hormonal and neural signals affecting hunger and satiety. Buchwald et al. [3] reported the rate of improvement in diabetes with bariatric surgery as 56.7, 79.7, 80.3, and 95.1% following adjustable gastric band (AGB), Roux-en-Y gastric bypass, and biliopancreatic diversion with duodenal switch (BPD-DS), respectively, in a meta-analysis. Complete diabetes remission was observed in 78% of the patients. The lipid profile is also improved in 70% of the patients after bariatric surgery. The total cholesterol, LDL, and triglyceride levels are decreased, but no significant

• Presence of full family and social support

• Laparoscopic adjustable gastric band (LAGB)

• The patient being well motivated and being informed about the surgery and its

• Lack of medical problems that will prevent the increased life expectation as a

• BMI >40 kg/m<sup>2</sup>

sequelae

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Mortality rates in bariatric surgical procedures are equal to those observed with small intra-abdominal operations such as laparoscopic cholecystectomy (0.3–0.6%) [4].
