Global Trends in Bariatric and Metabolic Surgery: Insights from the 2020–2021 IFSO Survey

Overview

The 2020–2021 IFSO survey reveals a global increase in bariatric and metabolic surgeries despite the COVID-19 pandemic, with sleeve gastrectomy remaining the predominant procedure. The survey highlights regional variations in procedure types, adoption of national protocols, and telemedicine use for patient follow-up.

Background

The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has conducted periodic surveys since 1997 to track global trends in bariatric and metabolic surgery (MBS). The 2018 survey established sleeve gastrectomy as the most common procedure, with declining use of adjustable gastric banding and rising popularity of one-anastomosis gastric bypass. The COVID-19 pandemic impacted elective surgeries worldwide, prompting IFSO to include questions on national COVID protocols, telemedicine adoption, and mortality data in the 2020–2021 survey. Data were collected from 57 of 74 national societies, representing diverse healthcare systems and data collection methods.

Data Highlights

Key Findings

• Sleeve gastrectomy (SG) remained the most commonly performed bariatric procedure worldwide from 2018 to 2021, increasing slightly in prevalence.
• The total number of bariatric and metabolic procedures decreased in 2020 due to the COVID-19 pandemic but rebounded in 2021.
• Adjustable gastric banding (AGB) usage continued to decline globally, with near abandonment in the Asia Pacific Chapter (APC).
• One-anastomosis gastric bypass (OAGB) maintained its position as the second most performed procedure, with slight regional variations.
• About half of the national societies had adopted COVID-19 protocols for bariatric surgery, and over 60% used telemedicine for patient follow-up during the pandemic.
• Data collection on mortality after bariatric surgery was reported by approximately 47% of societies, with no significant change between 2020 and 2021.

Clinical Implications

Clinicians should recognize sleeve gastrectomy as the predominant and increasingly favored bariatric procedure globally, reflecting its safety and efficacy profile. The decline of adjustable gastric banding suggests a shift away from less effective interventions. The adoption of telemedicine and national COVID-19 protocols highlights the importance of flexible patient management strategies during healthcare disruptions. Continued data collection on outcomes, including mortality, is essential to guide evidence-based practice.

Conclusion

The 2020–2021 IFSO survey underscores evolving global trends in bariatric surgery, with sleeve gastrectomy dominance and procedural adaptations influenced by the COVID-19 pandemic. These insights support informed clinical decision-making and highlight the need for ongoing surveillance of surgical practices and outcomes.

References

1. Scopinaro N, 1997 -- Presidential Address at the Second Congress of IFSO
2. IFSO Survey Reports, 2018 -- Trends in Bariatric Surgery
3. IFSO Position Statement, 2020 -- Recommendations During COVID-19