‘metabolic bariatric surgery’ (MBS). The word bariatric is derived from the Greek βάρος (baros) meaning heaviness or weight, with ἰατρός (iatros) referring to treatment or doctor. Surgery aimed at weight loss has been performed since the 1960s, but has proliferated since the introduction of laparoscopic techniques in 1994, when Alan Wittgrove performed the first laparoscopic Roux-en-Y gastric bypass (LRYGB).8 Surgical databases of the International Federation for Surgery for Obesity and Metabolic disorders (IFSO) and the Dutch Audit for the Treatment of Obesity (DATO) contain records of 189,719 bariatric cases worldwide in 2018, of which 11,494 in the Netherlands.9,10 The most common bariatric procedures are the Roux-enY gastric bypass (RYGB) and the sleeve gastrectomy (SG) (Figure 1).9 Other MBS procedures include the one-anastomosis gastric bypass (OAGB), and the adjustable gastric band (AGB). Figure 1: Metabolic Bariatric Procedures Worldwide, in Western Europe and the Netherlands in 2022 AGB = Adjustable Gastric Band, OAGB = One-Anastomosis gastric bypass, RYGB = Roux-en-Y gastric bypass, SG = Sleeve Gastrectomy Data derived from the 2018 registries of the International Federation for Surgery for Obesity and Metabolic disorders (IFSO) and the Dutch Audit for the Treatment of Obesity (DATO).9,10 International consensus guidelines advise to use MBS as a treatment option when a patients BMI exceeds 40 kg/m2, or 35 kg/m2 and is accompanied by associated diseases such as sleep apnea, hypertension, and non-alcoholic fatty liver disease.11 However, the most recent statement of the American Society for Metabolic & Bariatric Surgery (ASMBS) recommends MBS for patients with a BMI > 35 kg/m2 regardless of associated diseases, and for patients 1 9 General introduction and outline of this thesis
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