8
Metabolic and Bariatric Surgery
Common Surgical Procedures and Mechanisms
Sleeve Gastrectomy (SG)
➤ Procedure: Longitudinal resection of approximately 75% to 80% of
the stomach, creating a narrow gastric sleeve.
➤ Mechanism: Primarily restrictive; hormonal modulation via reduced
ghrelin and increased glucagon-like peptide 1 (GLP-1), and peptide YY.
➤ Effects: Decreased appetite, faster gastric emptying, preserved
pyloric function.
➤ Risks: Gastroesophageal reflux disease (GERD), staple-line leak,
hemorrhage.
➤ Role: Most common primary procedure; preferred for higher-risk
candidates.
Roux-en-Y Gastric Bypass
➤ Procedure: Creation of a small gastric pouch anastomosed to the
jejunum, bypassing the duodenum and proximal jejunum. The
remnant stomach remains in the body.
➤ Mechanism: Restrictive, mild malabsorption, hormonal changes,
including increased GLP-1 and altered bile acids.
➤ Effects: Reduced appetite, enhanced satiety, improved glycemic
control.
➤ Risks: Dumping syndrome, marginal ulcers, internal hernias,
vitamin B12 and iron deficiency.
➤ Role: Ideal for T2DM, GERD, or prior failed restrictive procedure.
