Contemporary overview of the bariatric-metabolic surgery
Authors:
M. Kasalický
Authors‘ workplace:
Chirurgická klinika 2. LF UK a ÚVN-VFN, přednosta: Prof. MUDr. M. Ryska, CSc.
Published in:
Rozhl. Chir., 2012, roč. 91, č. 1, s. 5-11.
Category:
Review
Overview
Introduction:
The increasing prevalence of obesity and type 2 diabetes mellitus (T2DM) worldwide may nowadays be regarded as a “twin” metabolic pandemic, causing the number of patients with the metabolic syndrome (MS) to rise rapidly. MS is a combination of several interrelated medical disorders such as obesity, T2DM, hypertension, dyslipidaemia etc. These conditions very frequently result in atherosclerosis, ischaemic heart disease, liver steatosis or even steatofibrosis. MS usually causes a significant worsening of the quality of life, often also leading to shortened life span. Bariatric, also referred to as metabolic (B-M), surgery currently represents a very powerful method for the treatment of morbid obesity and the metabolic syndrome.
Methods:
Contemporary bariatric-metabolic surgery uses either restrictive or malabsorptive methods, or a combination thereof. The purely restrictive procedures may include for instance adjustable gastric banding (AGB), and more recently also vertical gastric greater curvature plication. According to some authors, the purely restrictive methods include sleeve gastrectomy (SG); this procedure, besides restriction and a faster emptying of the residual stomach, has been proven to involve a hormonal effect (decreased plasma ghrelin level). Methods such as biliopancreatic diversion by Scopinaro (BPD/S) or its duodenal switch modification (BPD/DS), are regarded as purely malabsorptive. The Roux-en-Y gastric bypass (RYGBP), the most commonly used type of bypass surgery, represents a combination (restrictive-malabsorptive) method.
Results:
According to Buchwald’s meta-analysis, the total average weight loss after a B-M surgery was 38.5 kg, or 55.9% EBWL (Excess Body Weight Loss), regardless of the method and timing of the operation. Up to 2 years after the procedure, the average weight loss was 36.6 kg, or 53.8% EBWL, and more than 2 years after the procedure, the average weight loss was 41.2 kg, or 59% EBWL. T2DM was improved or resolved after the operation in 86.6% of cases. The best results of T2DM treatment were achieved after BPD/DS (95.1%). T2DM resolved after GBP in 80.3%, after SG in 75.8% and after AGB in 56.7% of obese diabetics.
Conclusion:
Treatment options for the metabolic syndrome include bariatric-metabolic surgery, preferably using the mini-invasive laparoscopic method. These procedures are indicated primarily in morbidly obese patients with BMI > 40 kg/m2 after conservative therapy failure, or patients with severe obesity (BMI > 35 kg/m2) associated with serious circulatory, metabolic or mobility complications. Moreover, surgical treatment of T2DM has been proven to be possible in the last decade.
Key words:
bariatric surgery – metabolic surgery – obesity – type 2 diabetes – metabolic syndrome
Sources
1. http://www.vzp.cz/klienti/aktuality/pruzkum-obezity-2011
2. Kasalicky M. Chirurgická léčba obezity. Ottova tiskárna, Praha, 2011.
3. Navarrete SA, Leyba JL, et al. Laparoscopic sleeve gastrectomy with duodenojejunal bypasses for the treatment of type 2 diabetes in non-obese patiens: technice and prelimitary results. Obes Surg 2011;5:663–667.
4. Ikramuddin S, Buchwald H. How bariatric and metabolic operations kontrol metabolic syndrome. BJS 2011; 98:1339–1341.
5. Buchwald H et al. Metabolic Surgery. New York, Grune a Stratton, 1978.
6. Deitel M. From bariatrie to metabolic surgery in non-obese subjekts: time for some caution. Arq Bras Endocrinol Metab 2009;(53)2:246–251.
7. Sjöström L, Narbro K, Sjöström CD, et al; Swedish Obese Subjects Study. Effects of bariatric surgery on mortal¬ity in Swedish obese subjects. N Engl J Med 2007;357(8):741–52.
8. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357(8):753–61.
9. Lacinová Z, Michalský D, Kasalický M, Dolinková M, Haluzíková D, Roubíček T, Krajíčková J, Mráz M, Matoulek M, Haluzík M. Vliv obezity na genovou expresi adiponektinu a jeho receptorů v subkutánní tukové tkáni. Vnitř Lék 2007;53(11):1005–1012.
10. Benedix F, Westphal S, Patschke E, et al. Weight Loss and Changes in Salivary Ghrelin and Adiponectin: Comparison Between Sleeve Gastrectomy and Roux-en-Y Gastric Bypass and Gastric Banding. Obes Surg 2011;21:616–624.
11. Murr M, Rafiei A, Habib A, Tannous KF: Overview of emerging concepts in metabolic surgery. Permanent Journal/Fall 2010;14(3):57–62.
12. Ramos A, Neto MG, Galvao M, et al. Laparoscopic great curvature placation: Initial results of an alternative restrictive bariatric procedure. Obes Surg 2010;20:913–918.
13. Talebpour M, Amoli BS. Laparoscopic total gastric vertical placation in morbid obesity. J Laparoendosc Adv Surg Tech A 2007;17(6):793–8.
14. Scopinaro N. Metabolic surgery. A new surgical discipline? Journal Med Sci 2010; 3(1):28–34.
15. Rubino F, Forgione A, Cummings DE, et al. The mechanism of diabetes kontrol after gastrointestinal bypass surgery revers a role of the proximal small intestine in the pathophysiology of type 2 diabetes. Ann Surg 2006; 244(5):741–9.
16. Deitel M. Update: Why diabetes does not resolve in some patiens after bariatrie surgery. Obes Surg 2011;21:794–796.
17. Melissas J, Daskalakis M, Koukouraki S, et al. Sleeve gastrectomy - a „foof-limiting“ operation. Obes Surg 2008;18:1251–6.
18. Nocca D, Guillaume F, Noel P, et al. Impact of laparoscopic sleeve gastrectomy and laparoscopic gastric bypass on HbA1c blood level and pharmacological tratment of type 2 diabetes mellitus in severe or morbidly obese patiens. Results of a multicenter prospective study at 1 year. Obes Surg 2011;21:738–743.
19. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: Systematic review and meta-analysis. Am J Med 2009;122:248–256.
20. Burstein R, Epstein Y, Charuzi I, et al. Glucose utilisation in morbidly obese subjects before and after weight loss by gastric bypass operation. Int J Obes Relat Metab Disord 1995;19:558–561.
21. Scopinaro N, Adami FG, Papadia FS, et al. The effects of biliopancreatic diversion on type 2 diabetes mellitus in patients with mild obesity (BMI 30–35 kg/m2) and simple overweight (BMI 25–30 kg/m2): A prospective controlled study. Obes Surg 2011;21:880–888.
Labels
Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2012 Issue 1
Most read in this issue
- Fascial closure of the abdominal wall by dynamic suture after topical negative pressure laparostomy treatment of severe peritonitis – results of a prospective randomized study
- Pharmacoresistant epilepsy after craniocerebral injury
- Urethral catheter as a risk factor of urologic complications after total knee arthoplasty – the retrospective analysis
- Stab wounds in children