Reduce the volume of intake. The best and most promising technique is currently the SLEEVE GASTRECTOMY, which also has a metabolic effect on intestinal hormones (incretins) that corrects DIABETES and improves other comorbidities such as dyslipidemia, hypertension or OSA. Since 2014 is the most commonly performed technique in the world.
Intragastric balloon, Lap-Band type ring or POSE, are inconsistent and expensive procedures with variable results, conditioning less weight loss and less maintained over the time, which determines a significant number of failures.
More than 80% of patients treated with intragastric balloons regain the weight lost 6 months after balloon withdrawal. More than 25% of patients with a ring or band will need revisional surgery due to unsatisfactory results and even more due to band complications (slippage or band gastric erosion). The success rate (loss> 50% of excess weight) is small after LapBand 55% at 3 years, 45% at 5 years and 35% at 8 years. Band failure numbers are already greater than successes. These results are as disappointing in the medium and long term as the ones obtained with the Vertical Banded Gastroplasty, fashionated in the 90s and already obsolete.
In addition to reducing the volume of intake a controlled malabsorption is associated. The best and most widely accepted all over the time procedure of all bariatric techniques for morbid obesity is LAPAROSCOPIC GASTRIC BYPASS. It is considered the Gold Standard to compare with other techniques. It has been the bariatric and metabolic technique most frequently performed in the world.
More aggressive techniques such as Duodenal Switch are indicated in very special cases of extreme obesity and by few surgical groups.
In recent years, new laparoscopic bariatric and metabolic techniques are being developed, such as SADI-s (variation of the classic Duodenal Switch), the mini-gastric bypass (Simplified bypass controversial for an increased risk of gastric pouch cancer), DUODENUM-ILEAL BYPASS with or without Sleeve Gastrectomy associated (metabolic promising technique for Diabetes), etc. All these new techniques still need the “test of time”.