The present and future of metabolic surgery

The term metabolic surgery has become familiar to the professional and lay public with the beginning of the new millennium. The focus is not only on weight reduction, but also on the improvement of obesity-related medical conditions. This is reflected in guidelines of surgical societies as well as in the therapeutic algorithms of other, for instance diabetology, societies. Standard procedures which represent a significant portion of the operations performed worldwide, along with procedures still lacking adequate proof of effectiveness, have been defined. There are also new types of interventions focusing rather on comorbidity treatment than on weight reduction. Effort to reduce invasiveness of the procedures has been evident, paving the way for endoscopic procedures with laparoscopic assistance or purely endoscopic procedures. The authors present the current view on the status of metabolic surgery, reporting on the most frequently performed procedures and also introducing newer surgical and endoscopic interventions which may represent the future of metabolic surgery.