Rational assessment of mainstream bariatric and metabolic surgical procedures performed in China / 中华消化外科杂志

ABSTRACT

Along with over half a century′s evolution of bariatric and metabolic surgery in the world, a variety of surgical procedures have emerged. The design concepts of bariatric and metabolic surgical procedure include shortening the effective length of small intestine to reduce nutrient absorption, reducing gastric volume to limit food intake, or the combination of shortening the length of small intestine and reducing gastric volume. However, majority of historic surgical procedures have become obsolete due to irrational design or poor clinical outcomes, for instance, procedures that simply shorten the length of small intestine. In order to become a standard surgical procedure, the assessment of a new surgical procedure usually need four phases including preclinical validation with animal experiments, clinical research and trial, clinical promotion, as well as official recommendation. During each phase, it is vital to collect the experimental and clinical data in order to establish an objective evaluation. Of all available bariatric and metabolic surgical procedures, laparoscopic adjustable gastric banding, sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), biliopancreatic diversion with duodenal switch (BPD-DS), single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S/SIPS) and intragastric balloon have satisfied all four phases mentioned above and therefore were recommended by most national professional associations in the world. In addition, mini gastric bypass /one anastomosis gastric bypass (MGB/OAGB) has also been recognized by the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). According to the actual situation in China, the views of professional associations in western countries and the existing clinical evidences, the authors suggest that the SG and RYGB should be classified as strongly recommended surgical procedures, SADI-S/SIPS be moderately recommended, and MGB/OAGB, sleeve gastrectomy and BPD-DS be recommended with caution in China. Currently, intragastric balloon products and endoscopic suture products have not been approved in China yet, and the other unmentioned bariatric and metabolic surgical procedures are either obsolete or with limited clinical evidences, therefore, they are not evaluated in this article.