Anatomy of bariatric surgery: comparison between the different procedures (Gastric Bypass, Sleeve, and Duodenal Switch)

Abstract

Obesity is a multifactorial condition characterized by excessive body fat accumulation, associated with various metabolic and cardiovascular comorbidities that compromise quality of life. Given the limitations of isolated clinical treatments, bariatric surgery has emerged as an effective alternative for weight control and improvement of associated diseases. This study aimed to compare the main bariatric procedures—Roux-en-Y Gastric Bypass, Sleeve Gastrectomy, and Duodenal Switch—regarding their anatomical, clinical, and metabolic aspects, analyzing their indications, advantages, and limitations. The research was conducted through an integrative literature review, with searches in the PubMed and Google Scholar databases, using the descriptors “Gastric Bypass,” “Sleeve,” and “Duodenal Switch,” including articles published between 2021 and 2025, following PRISMA criteria. Twenty studies were analyzed, providing a comprehensive understanding of the techniques and their clinical impacts. The results showed that bariatric surgery is one of the most effective approaches for treating morbid obesity, promoting significant weight loss and improvement or remission of comorbidities such as type 2 diabetes and hypertension. Roux-en-Y Gastric Bypass stood out for its efficacy in weight reduction and glycemic control due to hormonal changes and reduced intestinal absorption, although it carries a higher risk of nutritional deficiencies. Sleeve Gastrectomy, a less invasive restrictive technique, demonstrated good results in weight loss and a lower incidence of nutritional complications, despite an increased occurrence of gastroesophageal reflux. The Duodenal Switch, a more complex and less common procedure, proved effective in patients with superobesity, promoting substantial weight loss and improvement in comorbidities, but with a higher risk of vitamin deficiencies. The success of surgical treatment depends not only on the chosen technique but also on multidisciplinary follow-up involving physicians, nutritionists, and psychologists, as well as the patient’s adherence to lifestyle changes. The choice of procedure should be individualized, considering the patient’s clinical, anatomical, and psychosocial characteristics. It is concluded that bariatric surgery, in its various modalities, is a safe and effective intervention for obesity treatment, contributing to improvements in physical, metabolic, and emotional health. However, continuous follow-up and patient commitment are essential for maintaining the achieved benefits.