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<p>One- and two-step metabolic/bariatric surgery (MBS) procedures have become much safer; yet, some cases may still require revisional surgery. Conventional noninvasive medical management is significantly less effective and durable than MBS, and also, not risk free. The chronic relapsing nature of severe obesity and its comorbid diseases suggests the value of a <i>staged minimally invasive</i> (SMI) treatment approach that anticipates the necessity of long-term obesity management. SMI strategies consider briefer stepwise surgical and medical treatments that can be deployed serially and/or concomitantly. By modeling obesity management on principles similar to those of staged cancer or heart failure treatment, the SMI approach offers patients safe, flexible pathways wherein each treatment stage delivers meaningful efficacy and, if needed, a clear roadmap to the next best therapeutic option. This perspective article proposes a conceptual framework for consideration and research validation.</p>

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Optimizing Safety and Outcomes in Metabolic/Bariatric Surgery: A Conceptual Framework for Staged Minimally Invasive Treatment

  • 期刊论文

  • 发表日期：

    2026年2月5日

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  • Jaime Ponce,
  • Rami Lutfi,
  • Jane Buchwald,
  • Richard Peterson

摘要

One- and two-step metabolic/bariatric surgery (MBS) procedures have become much safer; yet, some cases may still require revisional surgery. Conventional noninvasive medical management is significantly less effective and durable than MBS, and also, not risk free. The chronic relapsing nature of severe obesity and its comorbid diseases suggests the value of a staged minimally invasive (SMI) treatment approach that anticipates the necessity of long-term obesity management. SMI strategies consider briefer stepwise surgical and medical treatments that can be deployed serially and/or concomitantly. By modeling obesity management on principles similar to those of staged cancer or heart failure treatment, the SMI approach offers patients safe, flexible pathways wherein each treatment stage delivers meaningful efficacy and, if needed, a clear roadmap to the next best therapeutic option. This perspective article proposes a conceptual framework for consideration and research validation.