Bariatric surgery and diabetes: Current challenges and perspectives

Table 1 Types of bariatric surgery, their respective weight loss potential, advantages, disadvantages and complications

Procedure	Target weight loss	Advantages	Disadvantages	Complications
Laparoscopic adjustable gastric banding	20%-25%	No anatomic alteration, removable, adjustable	Erosion, slip, and prolapse	Gastric ptosis, outlet obstruction, erosion of the gastric wall by gastric banding
Sleeve gastrectomy	25%-30%	Easy to perform, no anastomosis, reproducible, few long-term complications	Leaks difficult to manage, 20%-30% risk of GERD	Bleeding of the cutting edge, leakage and stenosis
Roux-en-Y gastric bypass	30%-35%	Effective for GERD, can be used as second stage after sleeve gastrectomy	Internal hernias possible, long-term micronutrient deficiencies	Anastomotic leakage, bleeding, incisional infection, anastomotic stenosis and malnutrition
Biliopancreatic diversion with duodenal switch	35%-45%	Long-lasting weight loss, especially effective in patients with very high BMI	GERD, potential for hernias, technically challenging	Diarrhoea, nutrient deficiency
Single anastomosisduodeno-ileal bypass with sleeve gastrectomy	35%-45%	Single anastomosis with strong metabolic effect and low rate of early complications	Nutritional and micronutrient deficiencies possible, duodenal dissection	GERD, bile reflux
Intragastric balloon	10%-12%	Endoscopic or swallowed, good safety profile	Temporary (6 months) therapy, early removal rate of 10%-19%	Abdominal pain, nausea and vomiting
One-anastomosisgastric bypass	35%-40%	Simpler to perform, strong metabolic effects, no mesenteric defects	Potential for bile reflux, long biliopancreatic limb	Malnutrition, diarrhea
Transpyloric bulb	14%	Outpatient endoscopic procedures with long implantation times	Gastric mucosal erosion	Gastric ulcer
Aspiration therapy	12%-14%	Endoscopy, treatment is completely reversible	Tube-related problems/complications, 26% early removal	Abdominal pain, gastrostomy site infection
Vagal nerve blocking therapy	8%-9%	No anatomic changes, low complication rate	Explant required for conversion to another procedure	Pain at neuroregulatory site, indigestion, nausea
Gastric electric stimulation	20%-30%	No anatomical changes, minimal surgical trauma, high surgical safety	Difficulty in determining electrode implantation position and electrical stimulation parameters	Perforation, electrode dislodgement, electrode failure
Left gastric artery embolization	3%-14%	No anatomical changes, minimal surgical trauma	Difficulty in selecting embolic materials and target vessels	Ulcer, abdominal pain, and vomiting

GERD: Gastroesophageal reflux disease; BMI: Body mass index.