Metabolic syndrome is strictly associated with morbid obesity and leads to an increased risk of cardiovascular diseases and related mortality. Bariatric surgery is considered an effective option for the management of these patients. We searched MEDLINE, Current Contents, and the Cochrane Library for papers published on bariatric surgery outcomes in English from 1 January 1990 to 20 July 2012. We reported the effect of gastrointestinal manipulation on metabolic syndrome after bariatric surgery. Bariatric surgery determines an important resolution rate of major obesity-related comorbidities. Roux-en-Y gastric bypass and biliopancreatic diversion appear to be more effective than adjustable gastric banding in terms of weight loss and comorbidities resolution. However, the results obtained in terms of weight loss and resolution of comorbidities after a “new bariatric procedure” (sleeve gastrectomy) encouraged and stimulated the diffusion of this operation. 1. Introduction In 2008 there were worldwide an estimated 1.5 billion adults overweight and 500 million obese. More than 40 million children are estimated to be overweight. Obesity rates have more than doubled since 1980, with 1 in 10 of the world’s adult western population now obese. Morbid obesity (BMI > 35) is responsible for more than 2.5 million deaths per year worldwide [1], and it has been estimated that life expectancy of a 25-year-old morbidly obese man is 12 years lower because of this condition. In morbidly obese patients, metabolic syndrome (MetS) is a constellation of metabolic abnormalities, including type 2 diabetes mellitus (T2DM), hypertension, dyslipidemia, and ovarian polycystic syndrome, that lead to an increased risk of cardiovascular diseases and related mortality [2]. The physiopathology of MetS is not completely known, but there is an intertwined link between obesity (BMI > 30), insulin resistance, and the MetS, which leads to a vicious cycle of metabolic stress with relevant clinical pattern [3]. Moreover, it has long been assumed that the presence of MetS is a risk factor for adverse outcomes in patients undergoing bariatric/metabolic surgery. In fact, in obese patients with MetS, central and visceral adiposity and hepatomegaly make bariatric surgery more technically challenging. Furthermore, in these patients MetS leads to a heightened state of systematic inflammation, with consequent lower ability to face the stress of bariatric surgery and limitations of body’s response to complications [4]. We describe the effects of the main laparoscopic bariatric/metabolic procedures on MetS
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