Metabolic and bariatric surgery: Surgical options and outcomes
DOI:
https://doi.org/10.7196/SAMJ.2025.v115i9b.3683Keywords:
Metabolic surgery, Bariatric surgery, Obesity, Guideline, South AfricaAbstract
RECOMMENDATIONS
1. MBS is recommended for individuals with a BMI >35 kg/m2, regardless of the presence, absence or severity of comorbidities,* to:
a) reduce long-term overall mortality (Level 2b, Grade B)
b) induce significantly better long-term weight loss compared with medical management alone (Level 1a, Grade A)[4]
c) induce control and remission of T2DM, in combination with best medical management, over best medical management alone (Level 2a, Grade B)
d) significantly improve QoL (Level 3, Grade C)
e) induce long-term remission of most obesity-related diseases, including dyslipidaemia (Level 3, Grade C),[8] hypertension (Level 3, Grade C) and MASLD (Level 3, Grade C).
2.MBS should be considered for individuals with metabolic disease and a BMI of 30 - 34.9 kg/m2*.
3.We suggest that the choice of metabolic and bariatric procedure be decided according to the patient’s need, in collaboration with an experienced MDT (Level 4, Grade D, Consensus).
4.We suggest that adjustable gastric banding should not be offered owing to unacceptable complications and long-term failure (Level 4,Grade D).
5.We suggest that one-anastomosis gastric bypass should not be routinely offered owing to long-term complications in comparison with standard Roux-en-Y gastric bypass (Level 4, Grade D).
*Recommendation 1 (Level 5, Grade D) and Recommendation 2 (Level 2a, Grade B).
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