Long-Term Follow-Up After Bariatric Surgery

The evolution of bariatric surgery has demonstrated that sustained weight loss and resolution of the metabolic syndrome are commonly seen postoperatively. The birth of metabolic surgery occurred with the observation that diabetes is almost always controlled and frequently in remission in these patients. Metabolic surgery results in sustained weight loss of approximately 30 % of baseline weight and over 60% of excess weight in large series and meta-analyses. The ability of metabolic surgery for diabetes remission has been verified with randomized controlled trials showing early remission. We and others have demonstrated that remission occurs in 62-97 % of diabetic patients who undergo metabolic surgery, with results in the higher end of this spectrum for the gastric bypass and duodenal switch. The other components of the metabolic syndrome also respond to metabolic surgery; over 80 and 60 % of hypertensive patients show improvement and resolution, respectively. Similar outcomes are reported for dyslipidemia and obstructive sleep apnea. There is evidence that metabolic surgery is associated with decreased cancer incidence, cancer-related mortality, cardiovascular risk, and overall mortality. At the same time, surgeons need to keep in mind the risk for malnutrition and vitamin and trace metal deficiencies that can be found in these patients. Vitamin B12 is most commonly deficient, but abnormalities in calcium, vitamin B6, vitamin D, iron, magnesium, copper, and zinc can be present. Metabolic surgery has allows us to care more effectively for the severely obese and diabetic patients, and represents one of the biggest medical milestones in our lifetime.