Two of the classic procedures are now almost entirely abandoned: gastric banding and biliopancreatic diversion.

Gastric banding, with some exceptions, is a procedure with a low complication rate, but it is not very effective for weight loss and has a high reoperation rate due to complications. It must also be remembered that it is the procedure that requires the highest level of cooperation and commitment—if the patient does not follow a diet, the procedure will not work.

On the other hand, biliopancreatic diversion remains the most effective procedure against obesity, type 2 diabetes, and hypercholesterolemia. However, the medium- to long-term complication rate is too high, and the fact that complications can arise so long after the procedure is concerning, as follow-up visits are often rare after 15 years.

Having lost these two procedures, which made the history of obesity surgery, others are emerging.

One, the single anastomosis bypass (also known as the minibypass or OAGB), which has now moved beyond the experimental phase, is an additional tool we will begin using in small numbers to determine if there is truly an advantage over the standard bypass. It should be clear that the misleading name (minibypass) causes confusion, because it is not a minibypass but rather a maxibypass, in the sense that, compared to the standard bypass, it is more malabsorptive and therefore more aggressive.

Another innovation should be the SAGI, a malabsorptive procedure that originates from the experience with the single anastomosis bypass and biliopancreatic diversion. It is still in the study phase but shows similar characteristics to biliopancreatic diversion, hopefully with fewer side effects.