Comparative Outcomes in Metabolic Surgery: Diabetes and Cardiovascular Health

The desire for weight loss may be the driving factor for many patients with obesity who seek evaluation for metabolic surgery. However, the benefits of metabolic surgery extend far beyond weight loss alone. Many patients undergoing metabolic surgery are able to achieve significant improvement in medical comorbidities including diabetes mellitus, hypertension, and hyperlipidemia, as well as decrease their risk of cardiovascular events. The most commonly performed metabolic surgery procedures currently are sleeve gastrectomy (SG), with more than 150,000 performed in 2021, and Roux-en-Y gastric bypass (RYGB), with more than 56,000 performed in 2021 (Estimate of Bariatric Surgery Numbers, 2011–2021 [WWW Document]. American Society for Metabolic and Bariatric Surgery; 2022. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers . Accessed 29 Oct 2023). Other procedures including biliopancreatic diversion with duodenal switch (BPD), single-anastomosis duodeno-ileostomy (SADI), and one-anastomosis gastric bypass (OAGB) are less commonly performed, but gaining acceptance. The different types of metabolic surgery may result in varying levels of improvement in medical comorbidities, but a positive impact can be seen with any metabolic surgery, even surgeries that are now rarely performed, such as vertical band gastroplasty (VBG) and adjustable gastric banding (AGB). This chapter will explore the physiologic changes induced by metabolic surgery and the impact on clinical outcomes with regards to diabetes and cardiovascular health.