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08-08-2014 | Metabolic surgery | Book chapter | Article

29. Operation of Choice for Metabolic Surgery

Authors: Philip R. Schauer, MD, Ali Aminian, MD, Stacy A. Brethauer, MD

Publisher: Springer New York

Abstract

In addition to achieving significant weight loss, bariatric/metabolic surgery causes improvement, and even complete remission, of type 2 diabetes mellitus (T2DM) in a substantial number of severely obese patients. Diabetic patients with body mass index (BMI) ≥35 kg/m2, especially those with other weight-related comorbidities and acceptable surgical risk and have not responded adequately to nonsurgical management, are candidates for metabolic surgery. Currently accepted metabolic operations include Roux-en-Y gastric bypass (RYGB), laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (SG), biliopancreatic diversion (BPD), and the duodenal switch variant (BPD-DS). The operations differ in the degree of benefit they impart on an individual’s state of metabolic profile. The general understanding, based on the results of limited high-quality trials, suggests the presence of an antidiabetic efficacy gradient among standard operations (i.e., BPD > RYGB > SG > AGB). More extensive diversionary procedures are generally associated with greater weight loss and more profound metabolic benefits in the long term, but at the cost of more surgical complications. The choice of metabolic surgery requires precise assessment of risk versus benefit for each operation and must be individualized for each patient. Patient’s operative risk and severity of T2DM are among the main determinants in the choice of metabolic surgery. In appropriate-risk patients with prediabetes or established T2DM, RYGB is the best overall option. The recommendations of this chapter are subject to change as more comparative studies become available.
Literature
1.
Dixon JB, Zimmet P, Alberti KG, Rubino F, International Diabetes Federation Taskforce on Epidemiology and Prevention. Bariatric surgery: an IDF statement for obese Type 2 diabetes. Surg Obes Relat Dis. 2011;7(4):433–47.PubMedCrossRef
2.
Rubino F, Kaplan LM, Schauer PR, Cummings DE, Diabetes Surgery Summit Delegates. The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus. Ann Surg. 2010;251(3):399–405.PubMedCrossRef
3.
Dixon JB, le Roux CW, Rubino F, Zimmet P. Bariatric surgery for type 2 diabetes. Lancet. 2012;379(9833):2300–11.PubMedCrossRef
4.
Rubino F, Schauer PR, Kaplan LM, Cummings DE. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61:393–411.PubMedCrossRef
5.
Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, et al. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995;222(3):339–50.PubMedCrossRefPubMedCentral
6.
Eldar S, Heneghan HM, Brethauer SA, Schauer PR. Bariatric surgery for treatment of obesity. Int J Obes (Lond). 2011;35:S16–21.CrossRef
7.
Carlsson LM, Peltonen M, Ahlin S, Anveden Å, Bouchard C, Carlsson B, et al. Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med. 2012;367(8):695–704.PubMedCrossRef
8.
Pories WJ. The IDF Statement: a big and long-awaited step for our diabetic patients. Obes Surg. 2011;21(10):1487–9.PubMedCrossRef
9.
Reoch J, Mottillo S, Shimony A, Filion KB, Christou NV, Joseph L, et al. Safety of laparoscopic vs open bariatric surgery: a systematic review and meta-analysis. Arch Surg. 2011;146(11):1314–22.PubMedCrossRef
10.
Shukla AP, Moreira M, Dakin G, Pomp A, Brillon D, Sinha N, et al. Medical versus surgical treatment of type 2 diabetes: the search for level 1 evidence. Surg Obes Relat Dis. 2012;8(4):476–82.PubMedCrossRef
11.
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.PubMedCrossRef
12.
Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122(3):248–56.PubMedCrossRef
13.
Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76.PubMedCrossRefPubMedCentral
14.
Mingrone G, Panunzi S, De Gaetano A, Guidone C, Iaconelli A, Leccesi L, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med. 2012;366(17):1577–85.PubMedCrossRef
15.
Dixon JB, O’Brien PE, Playfair J, Chapman L, Schachter LM, Skinner S, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. JAMA. 2008;299(3):316–23.PubMedCrossRef
16.
Sjöström L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Swedish Obese Subjects Study Scientific Group, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.PubMedCrossRef
17.
Adams TD, Pendleton RC, Strong MB, Kolotkin RL, Walker JM, Litwin SE, et al. Health outcomes of gastric bypass patients compared to nonsurgical, nonintervened severely obese. Obesity. 2010;18(1):121–30.PubMedCrossRefPubMedCentral
18.
Lee WJ, Chong K, Ser KH, Lee YC, Chen SC, Chen JC, et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Arch Surg. 2011;146(2):143–8.PubMedCrossRef
19.
Pournaras DJ, Osborne A, Hawkins SC, Vincent RP, Mahon D, Ewings P, et al. Remission of type 2 diabetes after gastric bypass and banding: mechanisms and 2 year outcomes. Ann Surg. 2010;252(6):966–71.PubMedCrossRef
20.
Pinheiro JS, Schiavon CA, Pereira PB, Correa JL, Noujaim P, Cohen R. Long-long limb Roux-en-Y gastric bypass is more efficacious in treatment of type 2 diabetes and lipid disorders in super-obese patients. Surg Obes Relat Dis. 2008;4(4):521–5.PubMedCrossRef
21.
Søvik TT, Aasheim ET, Taha O, Engström M, Fagerland MW, Björkman S, et al. Weight loss, cardiovascular risk factors, and quality of life after gastric bypass and duodenal switch: a randomized trial. Ann Intern Med. 2011;155(5):281–91.PubMedCrossRef
22.
Shimizu H, Timratana P, Schauer PR, Rogula T. Review of metabolic surgery for type 2 diabetes in patients with a BMI < 35 kg/m(2). J Obes. 2012;2012:147256.PubMedCrossRefPubMedCentral
23.
ASMBS position statement: bariatric surgery in class 1 obesity (BMI 30–35 kg/m2). http://​asmbs.​org/​2012/​09/​bariatric-surgery-in-class-1-obesity-bmi-30-35-kgm2/​. Accessed 17 Dec 2012.
24.
Meijer RI, van Wagensveld BA, Siegert CE, Eringa EC, Serné EH, Smulders YM. Bariatric surgery as a novel treatment for type 2 diabetes mellitus: a systematic review. Arch Surg. 2011;146(6):744–50.PubMedCrossRef
25.
Thaler JP, Cummings DE. Minireview: hormonal and metabolic mechanisms of diabetes remission after gastrointestinal surgery. Endocrinology. 2009;150(6):2518–25.PubMedCrossRef
26.
Lee H, Te C, Koshy S, Teixeira JA, Pi-Sunyer FX, Laferrère B. Does ghrelin really matter after bariatric surgery? Surg Obes Relat Dis. 2006;2(5):538–48.PubMedCrossRef
27.
Butner KL, Nickols-Richardson SM, Clark SF, Ramp WK, Herbert WG. A review of weight loss following Roux-en-Y gastric bypass vs restrictive bariatric surgery: impact on adiponectin and insulin. Obes Surg. 2010;20(5):559–68.PubMedCrossRef
28.
Laferrère B. Diabetes remission after bariatric surgery: is it just the incretins? Int J Obes (Lond). 2011;35:S22–5.CrossRef
29.
Peterli R, Steinert RE, Woelnerhanssen B, Peters T, Christoffel-Courtin C, Gass M, et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012;22(5):740–8.PubMedCrossRefPubMedCentral
30.
Unger RH. Lipotoxic diseases. Annu Rev Med. 2002;53:319–36.PubMedCrossRef
31.
Marroquí L, Gonzalez A, Ñeco P, Caballero-Garrido E, Vieira E, Ripoll C, et al. Role of leptin in the pancreatic β-cell: effects and signaling pathways. J Mol Endocrinol. 2012;49(1):R9–17.PubMedCrossRef
32.
Meier JJ, Nauck MA. Glucagon-like peptide 1(GLP-1) in biology and pathology. Diabetes Metab Res Rev. 2005;21(2):91–117.PubMedCrossRef
33.
Rao RS, Yanagisawa R, Kini S. Insulin resistance and bariatric surgery. Obes Rev. 2012;13(4):316–28.PubMedCrossRef
34.
Schauer PR, Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, et al. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003;238(4):467–84.PubMedPubMedCentral
35.
Mingrone G, Castagneto-Gissey L. Mechanisms of early improvement/resolution of type 2 diabetes after bariatric surgery. Diabetes Metab. 2009;35:518–23.PubMedCrossRef
36.
Rubino F, R’bibo SL, del Genio F, Mazumdar M, McGraw TE. Metabolic surgery: the role of the gastrointestinal tract in diabetes mellitus. Nat Rev Endocrinol. 2010;6:102–9.PubMedCrossRefPubMedCentral

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