Pathophysiological Basis and Clinical Efficacy of Bariatric Surgery in Morbid Obesity and Metabolic Syndrome

Morbid obesity is a systemic endocrine-metabolic disease characterized by chronic low-grade inflammation, insulin resistance, hormonal dysregulation (hyperestrogenemia, hyperghrelinemia, reduced GLP-1/PYY), gut microbiota dysbiosis, and endothelial dysfunction. In Kyrgyzstan, the prevalence of obesity reaches 25–28%, with more than 40% of patients with BMI >35 kg/m² suffering from type 2 diabetes mellitus (T2DM). A systematic review of 68 studies (2010–2025), including 18 randomized controlled trials and large registries (SOS, LABS, etc.), was conducted. Bariatric/metabolic surgery (primarily sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB)) provides sustained loss of 50–75% of excess weight over 5–20 years, T2DM remission in 70–92% (RYGB) and 50–70% (LSG), arterial hypertension remission in 60–70 %, dyslipidemia normalization in 70–80%, and resolution/improvement of obstructive sleep apnea in 85–90%. A significant reduction in cardiovascular risk was demonstrated (overall mortality ↓49 %, cardiovascular mortality ↓59%, myocardial infarction ↓42%, stroke ↓36%) and obesity-associated cancer risk by 38–60% (endometrial cancer ↓62%, hepatocellular carcinoma ↓65%). RYGB shows superiority over LSG in metabolic, cardiovascular, and oncological outcomes due to a more pronounced incretin effect and gut microbiota remodeling. The contemporary safety profile (30-day mortality 0.08–0.3%) and rapid cost-effectiveness (payback period in Kyrgyzstan 2–3 years) confirm the method’s priority status. In cases of morbid obesity unresponsive to conservative treatment, bariatric surgery should be considered first-line therapy. In Kyrgyzstan and Central Asia, it is essential to establish a national registry, implement ERABS protocols, train specialists, and include these procedures in the mandatory health insurance system.