Bariatric–Metabolic Surgery: The State of the Art and the Management of Complications

Bariatric surgery is a highly effective therapeutic strategy in the treatment of severe obesity, but it carries significant risks, both in the short and long terms. However, many of these complications can be avoided by appropriate patient selection, comprehensive assessment of clinical conditions, and structured follow-up including clinical, nutritional, and psychological monitoring. Achieving these objectives requires a meticulous program involving the entire multidisciplinary team and lays the foundations for proper patient compliance. Furthermore, recent studies have begun to explore the systemic effects of bariatric-metabolic surgery, with benefits extending far beyond simple weight loss and effects on both morbidity and mortality. Research has documented improvements in cardiovascular risk factors, insulin sensitivity, and hormonal balance, with substantial effects on the three main comorbidities of obesity: cardiovascular risk and hypertension, T2DM, and OSAS. In conclusion, bariatric surgery, while highly effective in treating severe obesity and its comorbidities, involves significant anatomical and physiological changes that alter nutrient absorption and digestion. These changes can lead to a number of short-, medium-, and long-term nutritional complications that require close monitoring and targeted dietary interventions.