Management of Comorbidities Relevant to Metabolic and Bariatric Surgery

Publication Date: December 11, 2024
Last Updated: December 18, 2024

Summary of Recommendations

The panel suggests routine intraoperative imaging of the biliary anatomy in patients with bypass-type anatomy undergoing laparoscopic cholecystectomy (expert opinion recommendation due to low-quality of evidence). (U, CC)
620
The panel suggests medical therapy be trialed as first line therapy in patients with GERD post-sleeve gastrectomy (expert opinion recommendation due to low-quality of evidence). (U, CC)
  • If the patient has medically refractory GERD post-sleeve gastrectomy and has a BMI > 35, the panel suggests conversion to RYGB. For patients with medically refractory GERD with BMI < 35, the data is are clear on whether RYGB or MSA would be superior.
  • For patients with a BMI between 30 and 35, consideration should be given for gastric bypass if the patient has associated metabolic diseases. For patients with BMI < 30, potential options for antireflux surgery include MSA and procedures that include gastric diversion.
  • When present, a hiatal hernia should be surgically repaired and in select circumstances it may be the only surgical intervention required.
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The panel suggests sleeve gastrectomy rather than bypass for obese patients with IBD (conditional recommendation, very low certainty evidence). (C, VL )
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Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Management of Comorbidities Relevant to Metabolic and Bariatric Surgery

Authoring Organization

Society of American Gastrointestinal and Endoscopic Surgeons

Publication Month/Year

December 11, 2024

Last Updated Month/Year

December 18, 2024

Document Type

Guideline

Country of Publication

US

Document Objectives

Patients who are under consideration for or have undergone metabolic and bariatric surgery frequently have comorbid medical conditions that may make their perioperative care more complex. These recommendations address routine intraoperative cholangiography in patients with bypass-type anatomy, the management of reflux disease after sleeve gastrectomy, and the optimal bariatric procedure for patients with comorbid inflammatory bowel disease.These recommendations should provide guidance regarding management of these comorbidities in patients who are under consideration for or have undergone metabolic and bariatric surgery. These recommendations also identify important areas where the future research should focus to strengthen the evidence base.

PICO Questions

  1. Should routine IOC or alternative options be used for patients with gastrointestinal bypass-type anatomy (RYGB and DS, etc.) undergoing cholecystectomy?

  2. Should surgical or medical therapy be used for GERD post-sleeve gastrectomy?

  3. Should sleeve gastrectomy or Roux en Y gastric bypass be used for obese patients with IBD undergoing metabolic and bariatric surgery?

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient, Operating and recovery room

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Management

Diseases/Conditions (MeSH)

D050110 - Bariatric Surgery

Keywords

bariatric surgery, metabolic surgery

Source Citation

Kumar SS, Wunker C, Collings A, Bansal V, Zampou T, Chang J, Rodriguez N, Sabour A, Hilton LR, Ghanem OM, Kushner BS, Loss LJ, Aleassa EM, Haskins IN, Ayloo S, Reid A, Overby DW, Hallowell P, Kindel TL, Slater BJ, Palazzo F. SAGES guidelines for the management of comorbidities relevant to metabolic and bariatric surgery. Surg Endosc. 2024 Dec 11. doi: 10.1007/s00464-024-11433-2. Epub ahead of print. PMID: 39663246.