Bariatric surgery.

Background: In 2023, 15,985 primary bariatric operations were performed in Australia, with sleeve gastrectomy (SG) accounting for 80% of cases. Bariatric surgery offers better long-term weight loss and comorbidity resolution compared with any other treatments, with low morbidity and mortality rates.

Objective: This paper evaluates the efficacy, indications, outcomes and long-term considerations of bariatric surgery. It compares the current surgical procedures, SG, Roux-en-Y gastric bypass (RYGB) and one-anastomosis gastric bypass (OAGB), along with alternative weight-loss treatments, focusing on the important aspects for an Australian general practitioner.

Conclusions: Bariatric surgery remains the most effective treatment for people with obesity, initially achieving 30% total weight loss (TWL) with sustained long-term outcomes. Both SG and RYGB show similar TWL rates at five years (23.7% vs 27.2%). Complication rates are low (1.5-4.8%), and surgery significantly improves or resolves comorbidities, particularly diabetes. Endoscopic and pharmacological treatments are emerging alternatives but lack the long-term efficacy of surgery.