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Bariatric surgery current perspective
By Dr.G.Vivekanand| 0 Comments

Obesity and type 2 diabetes mellitus (T2DM) are becoming epidemic diseases worldwide. These two diseases are closely related and both are very difficult to treat. Bariatric surgery, aimed at weight reduction, has been proven to be a viable option for the treatment of severe obesity in comparison to conservative methods, resulting in long-lasting weight loss, improved quality-of-life, and the resolution of obesity-related co-morbidities.Among all of the obesity-related co-morbidities, bariatric surgery has been proven especially successful in treating as well as preventing type 2 diabetes mellitus in morbidly obese patients (BMI > 33 Kg/m2). Recently, gastrointestinal metabolic surgery has been proposed as a new treatment modality for type 2 diabetes mellitus in patients with lower body mass index (BMI < 33 Kg/m2). Several randomized trials have proven that bariatric surgery resulted in better blood sugar control compared with medical treatment in diabetic patients with lower BMI. Therefore, it is not surprising that the number of bariatric surgeries worldwide has grown rapidly over the past decade, including Asia.

Improved safety

The most important technique change in bariatric is from open surgery to laparoscopic surgery. Improvement in technology and experience has dramatically improved the safety of this procedure. Recent reports have confirmed that bariatric/metabolic surgery can be performed as safe as laparoscopic cholecystectomy with operation mortality around 0.1%.

Common,bariatric/metabolic procedures,Laparoscopic sleeve gastrectomy(LSG), a vertical gastrectomy-that leaves a narrow gastric tube along the lesser curvature of the stomach, has been accepted as a primary procedure for morbid obese patients recently because of its simplicity and effectiveness. Several randomized trials also demonstrated that LSG has a similar efficacy of weight reduction comparing to Roux-en-Y gastric bypass (RYGB) at short to mid-term.

Laparoscopic Mini Gastric Bypass:-Another important recent change of technique is from two anastomosis Roux-en-Y Bypass to single loop anastomosis technique, the laparoscopic mini gastric bypass(MGB). The elimination of one anastomosis may reduce operative time and decrease the possibility of surgically related complication.

Patient selection

Although not a perfect one, the BMI; surrogate of obesity, is now the most important indicator of bariatric surgery as well as metabolic surgery for diabetes treatment. Indication for bariatric surgery was universally accepted for BMI > 33 Kg/m2 (in Asians) with co-morbidities. However, recent study has shown that BMI did not predict the effect of bariatric surgery on mortality or cardiovascular disease and patients who may benefit from bariatric surgery are those with insulin resistance. These findings are very important in patient selection and may be incorporated into indication for bariatric surgery in the future. More importance should be given to metabolic variables and less to BMI.

ABCD Diabetes Surgery Score

A simple scoring system consisted of our variables – the age, BMI, C-peptide and duration of diabetes- was developed for predicting the success of diabetic treatment after metabolic surgery. This simple multidimensional grading system can predict the success of diabetic treatment and is clinically recommended.Laparoscopic bariatric/metabolic surgery is becoming a safe and effective treatment and a life saving procedure for morbid obesity and obese type 2 diabetic patients. Good patient selection and durable weight loss with resolution of comorbidities remain the cornerstones of the success of bariatric surgery.



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